Short- and Long-Term Outcomes of Endoscope-Assisted Laparoscopic Wedge Resection for Gastric Submucosal Tumors Adjacent to Esophagogastric Junction

Ye, Xin; Yu, Jiang; Kang, Weiming; Ma, Zhiqiang; Xue, Zhigang

doi:10.1007/s11605-017-3628-2

Cited by 12 publications

(10 citation statements)

References 38 publications

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“…Li et al [12] в работе, посвящённой особенностям трансгастральной резекции желудка, сделали вывод, что операция должна выполняться под эндоскопическим контролем, а опухоль извлекаться через просвет пищевода, что снижает риск опухолевой диссеминации и контаминации желудочной флоры по брюшной полости. Таким образом, трансгастральная резекция при расположении опухоли в области КЭП, задней стенки и антрального отдела желудка является оправданной методикой, улучшающей непосредственные и отдалённые результаты хирургического лечения пациентов с мезенхимальными опухолями желудка [6,13]. Операция проводится под четким визуальным контролем и не требует интраоперационной ЭГДС для обнаружения опухоли.…”

Section: Discussionunclassified

Method for laparoscopic transgastral resection for mesenchimal gastric tumors

et al. 2022

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The purpose of the study was to evaluate the efficacy and safety of laparoscopic transgastric resection for mesenchymal tumors of the proximal stomach.Material and Methods. A retrospective-prospective study was carried out. Surgical techniques of laparoscopic transgastric resection and the history of the development of this surgical method were described in detail. A total of 11 laparoscopic transgastric resections were performed. The course of the postoperative period and the postoperative management of patients were described. The immediate and long-term results of surgical treatment and the quality of life of patients were presented.Results. The assessment of the quality of life of patients after surgery showed that there were no cases of gastroesophageal reflux disease compared to proximal subtotal resection of the stomach or endoscopic tunnel resection. All patients underwent radical resection. In our study, we did not encounter cases of conversion of the surgical approach, as well as serious postoperative complications (Clavien–Dindo>III ). The analysis of long-term treatment outcomes showed that there were no cases of recurrence or disease progression. All patients are alive and followed up.Conclusion. This technique is fully justified, with careful selection of patients and compliance with all the rules of surgical oncology. Transgastric resection of gastric mesenchymal tumors located in the region of the cardioesophageal junction is a justified and safe technique. Surgery is performed under clear visual control, EGDS is not required to detect the tumor. This method allows the reduction of the frequency of contamination of the gastric flora into the abdominal cavity as well as the reduction of the wound area of the anterior abdominal wall.

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Section: Discussionunclassified

Method for laparoscopic transgastral resection for mesenchimal gastric tumors

et al. 2022

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“…Recent advances in laparoscopic technique and the emergence of minimally invasive instruments have increased the safety and effectiveness of laparoscopic surgery for EGJ-GISTs (13)(14)(15). The key point of laparoscopic surgery of EGJ-GISTs is to achieve microscopic negative margins on final pathology while also retaining the function of the lower esophageal sphincter (LES) without rupturing the tumor pseudocapsule (3,4).…”

Section: Discussionmentioning

confidence: 99%

Nomogram for Predicting Risk of Esophagogastric Junction (EGJ) Resection During Laparoscopic Resection of Gastrointestinal Stromal Tumors in EGJ: A Retrospective Multicenter Study

Luo

Feng

et al. 2021

Front. Surg.

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Background: The established criteria for determining whether to excise the cardia during laparoscopic surgery for gastrointestinal stromal tumors in the esophagogastric junction (EGJ-GISTs) remain controversial. This retrospective multicenter study was conducted to develop a nomogram for predicting the risk of the cardia excision during laparoscopic surgery for EGJ-GISTs.Material and Methods: We reviewed data from 2,127 gastric-GISTs (g-GISTs) patients without distant metastases in four hospital between June 2012 and June 2020. Of those, according to the including criteria, 184 patients [Guangdong Provincial Hospital of Chinese Medicine (n = 81), Nanfang Hospital of Southern Medical University (n = 60), Guangdong General Hospital (n = 34), and The Third Affiliated Hospital of Southern Medical University (n = 9)] with EGJ-GISTs were identified and included in this study. Factors contributing to risk of cardia excision were identified and used to create a nomogram. Nomogram performance was assessed using a bootstrapped concordance index (c-index) and calibration plots.Results: According to the multivariate analysis, the distance from the margin of the tumor to the esophagogastric line (EG-line) (cm) (OR = 0.001, 95% CI: 0.00001~0.056, P = 0.001) and tumor size (cm) (OR = 14.969, 95% CI: 1.876~119.410, P = 0.011) were significantly related to likelihood of cardia structure excision in laparoscopic surgery for EGJ-GISTs. These two factors were used to generate a nomogram for predicting risk of cardia excision using a logistic regression model; a bootstrapped C-index of 0.988 (calibrated C-index = 0.987) indicated strong predictive ability, with broad calibration.Conclusions: This nomogram based on distance from tumor margin to EG-line and tumor size may serve as a tool for predicting risk of cardia damage during laparoscopic removal of EGJ-GISTs to aid in selection of surgical methods and preoperative neoadjuvant therapy.

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“…For lesions located near gastric cardia or pylorus, larger gastric GISTs, or to perform ERCP after RYGB, endoscopic therapy, or conventional laparoscopic operations could be technically challenging and need longer operative time, with lower successful rate or increasing risk of postoperative complications. [6][7][8][9]22 So, in this study, our research group have developed a novel technique, IGS, which has been successfully applied for the abovementioned challenging situations.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] However, for special clinical situations, the current therapeutic methods require special expertise and devices, which will be technically much more difficult and need longer operative time. [6][7][8][9] This is especially true for situations such as full-thickness excision for larger gastric tumors or tumors located in unfavorable sites (adjacent to esophagogastric junction or gastric pylorus) or performing endoscopic retrograde cholangiopancreatography (ERCP) for patients who have previously undergone RYGB.…”

Section: Introductionmentioning

confidence: 99%

Intragastric Single-Port Surgery: An Innovative and Multipurpose Technique for the Therapy of Upper Digestive Tract Lesions

Veltzke‐Schlieker

Adler

et al. 2021

Surg Innov

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Background: Endoscopic treatment can represent a technical challenge for several special situations, such as resecting gastric tumors with larger size or in unfavorable sites and performing endoscopic retrograde cholangiopancreatography (ERCP) after Roux-en-Y gastric bypass (RYGB). This study aims to describe an innovative and multipurpose technique, intragastric single-port surgery (IGS), which can be applied for abovementioned special situations and for assessing its safety, feasibility, and efficacy. Methods: IGS technique was performed through a 2–3 cm skin incision, where the stomach wall is exteriorized and fixed to the skin. The single-port device is inserted and intragastric access is gained for laparoscopic or endoscopic instruments. Three purposes of IGS were performed: (1). gastric intraluminal lesions resection; (2). to perform ERCP after RYGB; and (3). revision of pancreaticogastric anastomosis after pylorus-preserving pancreaticoduodenectomy. Results: IGS was performed successfully in 20 patients. Ten patients underwent gastric intraluminal lesion resection, mostly for gastric gastrointestinal stromal tumors (n = 7, 70%); all pathological specimens were with negative margin, mean operation time was 102.3 ± 43.5 minutes, and mean postoperative hospital stay was 4.6 ± 1.5 days. Nine patients underwent ERCP after RYGB, cleaning of the bile duct was successful in all patients (100%), and mean operation time and mean postoperative hospital stay were 140.6 ± 46.3 minutes and 4.4 ± 2.6 days, respectively. One patient underwent pancreaticogastric anastomosis revision. There were no mortalities in our series. Conclusions: IGS is a safe, feasible, and effective technique for gastric intraluminal lesion resection and for performing ERCP after RYGB, while it has the potential for other future applications.

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Short- and Long-Term Outcomes of Endoscope-Assisted Laparoscopic Wedge Resection for Gastric Submucosal Tumors Adjacent to Esophagogastric Junction

Abstract: Endoscope-assisted LWR is safe, feasible, and effective for gastric SMTs near the EGJ. LTWR is preferable to LEWR for gastric SMTs in the posterior wall, those with intraluminal growth, and those closer to the EGJ.

Cited by 12 publications

References 38 publications

Method for laparoscopic transgastral resection for mesenchimal gastric tumors

Method for laparoscopic transgastral resection for mesenchimal gastric tumors

Nomogram for Predicting Risk of Esophagogastric Junction (EGJ) Resection During Laparoscopic Resection of Gastrointestinal Stromal Tumors in EGJ: A Retrospective Multicenter Study

Intragastric Single-Port Surgery: An Innovative and Multipurpose Technique for the Therapy of Upper Digestive Tract Lesions

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