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Kansoun A, Omouri A, Hamed S. Minimally invasive resection of gastric GIST tumor by trans-gastric approach: A case report of a novel technique. Int J Surg Case Rep 2024; 122:110178. [PMID: 39153340 PMCID: PMC11378970 DOI: 10.1016/j.ijscr.2024.110178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 08/10/2024] [Accepted: 08/14/2024] [Indexed: 08/19/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE GIST (Gastro Intestinal Stromal Tumor) treatment is surgical however surgical resection, especially for gGIST (gastric GIST), may be challenging due to location of tumor and the possible sequelae post resection. CASE PRESENTATION We present a case of 66-year-old female presented for the management of gGIST. We opted for transgastric resection assisted by robot. The resection was with free surgical margins for a 4 cm GIST tumor low in grade. CLINICAL DISCUSSION Classical wedge resection of gastric tumors poses post-operative complications especially if the tumor is located near the cardia or pylorus. Various minimally invasive techniques were described aiming to avoid post-operative complications as in stenosis and gastric reflux. CONCLUSION Minimally invasive transgastric resection of gGIST tumor seems to be worth of attention for it can prevent stenosis, hemorrhage and can preserve gastric tissue. Further studies need to be involved to endorse this technique.
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Affiliation(s)
- Alaa Kansoun
- Department of Visceral and Endocrine Surgery, Saint Joseph Hospital, Marseille 13008, France.
| | - Adel Omouri
- Department of Viscerale Surgery, Aix-Marseille University, Faculty of Medical Sciences, Marseille, France
| | - Sami Hamed
- Department of Visceral and Endocrine Surgery, Saint Joseph Hospital, Marseille 13008, France
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Dzhantukhanova SV, Starkov YG, Kontorshchikov PK, Zamolodchikov RD. [Hybrid laparo-endoscopic gastric resection for non-epithelial pyloric tumor]. Khirurgiia (Mosk) 2022:140-145. [PMID: 35658146 DOI: 10.17116/hirurgia2022061140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In January 2020, a patient with a gastrointestinal stromal tumor of the antrum located in close proximity to the pylorus underwent a hybrid laparo-endoscopic organ-sparing gastric resection. There were no intraoperative and postoperative complications. Control endoscopic and X-ray examination of the stomach confirmed normal motor and evacuation function of the stomach. To date, follow-up period is more than 1.5 years. The patient has no complaints. This case demonstrates clear advantages of hybrid access in certain clinical situations, such as localization in anatomically difficult areas and near functional sphincters. Surgical approach ensured pylorus-sparing resection with favorable postoperative result.
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Affiliation(s)
| | - Yu G Starkov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | | | - R D Zamolodchikov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
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Mishra R, Gautam S, Misra S. Laparo-endoscopic transgastric resection of gastric gastrointestinal stromal tumor located near the gastro-oesophageal junction with hiatus hernia repair. J Minim Access Surg 2021; 18:459-462. [PMID: 35046165 PMCID: PMC9306126 DOI: 10.4103/jmas.jmas_203_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 63-year-old male presented to us with upper abdominal pain and odynophagia for 3 months. Contrast-enhanced computed tomography of the abdomen revealed hiatus hernia with ulceroproliferative growth involving the gastro-oesophageal (GE) junction and cardia of the stomach with no obvious transserosal extension. Upper gastrointestinal (GI) endoscopy was suggestive of a tumour of size 3 cm × 3 cm near the GE junction and sliding hiatus hernia. Although there are various ways described in the literature for managing GI stromal tumour (GIST), we opted for laparo-endoscopic transgastric resection with hiatus hernia repair due to obvious advantages in terms of safety and efficacy. Just a handful of cases have been described in the literature being treated in this fashion. The procedure was successfully performed as evidenced by an uneventful recovery of the patient. His histopathology report was suggestive of GIST of size 3.5 cm × 3.0 cm × 2.0 cm. The resected margins were free of the tumour.
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Affiliation(s)
- Richa Mishra
- Department of Gastrointestinal and Bariatric Surgery, Apollo Hospitals, Bengaluru, Karnataka, India
| | - Suryanarayan Gautam
- Department of Gastrointestinal and Bariatric Surgery, Apollo Hospitals, Bengaluru, Karnataka, India
| | - Saurabh Misra
- Department of Gastrointestinal and Bariatric Surgery, Apollo Hospitals, Bengaluru, Karnataka, India
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Abstract
BACKGROUND Technological and operative advancements have allowed laparoscopic intragastric surgery (LIGS) to be applied in the treatment of superficial gastric or submucosal lesions. The aim of this study was to evaluate short- and long-term outcomes following LIGS. METHODS From 2000 to 2013, 25 LIGSs were performed for superficial gastric lesions. Clinical records were reviewed retrospectively for peri-operative course and long-term outcomes with particular attention to the oncological follow-up for patients with malignant lesions. RESULTS Nineteen (76%) lesions were located close to the EGJ, three (12%) in the lesser curvature, two (8%) in the posterior wall and one (4%) in the prepyloric-antral region. A multiport technique was used in 15 (60%) patients and a single-access approach in 10 (40%) patients. The median operative time was 140 (50-210) minutes. No conversion to open or conventional laparoscopic surgery was needed. Mortality was nil, and severe morbidity occurred in one (4%) patient. The median length of stay was 6 (3-10) days. Indications of LIGS were adenocarcinoma in 11 (44%) patients, gastrointestinal stromal tumors (GISTs) in 6 (24%) patients and benign lesions in eight (32%) patients. En bloc resection was obtained in 24 (96%) patients with R0 margins in 23 (92%) patients. After a median follow-up of 76 (26-171) months, recurrence was detected in 4 (36%) patients with advanced malignant adenocarcinoma. CONCLUSION LIGS provides an interesting alternative to major gastric and EGJ resection when endoscopic resection is not suitable for highly selected patients with superficial gastric lesions.
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Laparoscopic Intragastric Resection: An Alternative Technique for Minimally Invasive Treatment of Gastric Submucosal Tumors. Ann Surg 2019; 267:e12-e16. [PMID: 27926576 DOI: 10.1097/sla.0000000000002099] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To present the technique for and early results of laparoscopic intragastric resection (LIGR). BACKGROUND Treatment of confirmed or suspected submucosal gastric malignancies relies on clear margin resection, for which minimally invasive surgery is widely accepted. However, resection in some localization remains challenging. METHODS We present the steps of LIGR for gastric submucosal tumors (GSMTs). We report the results of LIGR in consecutive patients operated at 2 institutions, including intraoperative, pathologic, 30-day major morbidity and mortality characteristics. RESULTS After laparoscopic access to the abdominal cavity, cuffed gastric ports are placed to approximate the anterior gastric wall to the abdominal wall. A pneumogastrum is created. The tumor is resected in the submucosal plane and the deficit closed with intragastric suturing. Specimen extraction is performed perorally or through a gastrotomy site. In 8 proximal intraluminal GSMTs with median size of 3.1 cm (range: 1.8-6.0 cm), median operative time was 167.5 minutes (range: 120-300 mins). There was no major morbidity and no mortality. All resections were R0. CONCLUSIONS We illustrate the technique of a novel, feasible, and safe minimally invasive approach to GSMTs. LIGR is an alternative to resect challenging GSMTs by limiting surgical invasiveness and preserving gastrointestinal function.
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Response to Comment on "Laparoscopic Intragastric Resection: An Alternative Technique for Minimally Invasive Treatment of Gastric Submucosal Tumors". Ann Surg 2018; 270:e28-e29. [PMID: 30256227 DOI: 10.1097/sla.0000000000003063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ojima T, Nakamura M, Nakamori M, Takifuji K, Hayata K, Katsuda M, Takei Y, Yamaue H. Laparoscopic and endoscopic cooperative surgery is a feasible treatment procedure for intraluminal gastric gastrointestinal stromal tumors compared to endoscopic intragastric surgery. Surg Endosc 2017; 32:351-357. [DOI: 10.1007/s00464-017-5683-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/19/2017] [Indexed: 12/14/2022]
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Kanehira E, Tanida T, Kamei A, Nakagi M, Yoshida T, Touma S. Needlescopic intragastric surgery facilitated by newly developed 2mm instruments. MINIM INVASIV THER 2016; 25:210-4. [PMID: 27228009 DOI: 10.1080/13645706.2016.1181092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Intragastric surgery is a percutaneous endoluminal surgery in the stomach aimed at resection of tumors located at the esophagogastric junction (EGJ). We developed needlescopic intragastric surgery performed via 2 mm, 2 mm, and 5 mm ports (PEIGS-225). MATERIAL AND METHODS In cooperation with Niti-On Co., Ltd. we developed a series of 2 mm instruments including grasping forceps, a cannula, a laparoscope, an electrocautery, scissors, and a needle holder. OPERATIVE TECHNIQUE Two 2 mm trocars and a 5 mm one are inserted into the gastric lumen percutaneously. Intragastric procedures are performed by the instruments brought through those three ports. The specimen is extracted via the esophageal-oral route. The defect in the gastroesophageal wall is closed by hand-suture. After the intragastric procedure, the 5 mm stab wound on the gastric wall is closed by hand-suture, while the 2 mm wounds are left untreated. PATIENTS Between March and August 2015 PEIGS-225 was performed in five patients. RESULTS There was no operative conversion. The mean operation time was 96 minutes. There were no perioperative complications. Pathological findings indicated that the margin was negative in all cases. CONCLUSION Needlescopic intragasric surgery performed via the smallest access (2 mm, 2 mm, 5 mm) is enabled by the 2 mm instruments developed by us.
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Affiliation(s)
| | | | - Aya Kamei
- a Department of Surgery , Medical Topia Soka
| | | | | | - Sachiko Touma
- b Department of Gastroenterology , Medical Topia Soka
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Comparison of minilaparoscopy and single-incision intragastric surgery for gastric submucosal tumor resection in a porcine model. Surg Endosc 2016; 30:4489-98. [PMID: 26895907 DOI: 10.1007/s00464-016-4781-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 01/21/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND The aim of this study was to develop an easy-to-induce and reproducible model of gastric submucosal tumor in swine to compare minilaparoscopy (ML) with single-incision (SI) intragastric surgery. METHODS Twelve healthy female pigs (weight 30.94 ± 2.49 kg) underwent a transparietal injection of sterile alginate at the level of Z-line (n = 6) and at the pre-pyloric area (n = 6) creating a model of gastric submucosal pseudotumor. The operative procedures included intragastric resection with ML and SI approaches of cardiac and pre-pyloric lesions, with gastroscopic assistance. After resection, the gastric mucosal layer was closed using intracorporeal sutures. The operative time, complication rate and clinical evolution after 1 month were compared in the four groups that the pigs were arranged. RESULTS The pseudotumors ranged in size from 3 to 6 cm in diameter. The access of the gastric cavity and resection of the experimental SMP and suturing of the mucosa were performed successfully in 12 animals using both approaches. Mean time to perform the exeresis of gastric cardia tumors was significantly higher in single-incision approach. No significant differences were observed in the surgical time during pyloric surgery. Minilaparoscopic approach reduced significantly the mucosa closure time in esophagogastric and pyloric pseudotumors. One month after, no alterations were shown in the abdominal cavity using exploratory laparotomy. CONCLUSIONS The technical feasibility of performing safe and efficient intragastric approach of submucosal pseudotumors in swine model was verified in this study. Intragastric ML has advantages over SI, namely regarding the reduction in total surgical times and the fewer technical difficulties.
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Kwon OK, Yu W. Endoscopic and Laparoscopic Full-Thickness Resection of Endophytic Gastric Submucosal Tumors Very Close to the Esophagogastric Junction. J Gastric Cancer 2015; 15:278-85. [PMID: 26819807 PMCID: PMC4722995 DOI: 10.5230/jgc.2015.15.4.278] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 12/09/2015] [Indexed: 12/13/2022] Open
Abstract
Purpose Gastric submucosal tumors (SMTs) located very close to the esophagogastric junction (EGJ) are a challenge for gastric surgeons. Therefore, this study reports on the experience of using endoscopic and laparoscopic full-thickness resection (ELFR) with laparoscopic two-layer suturing in such tumors. Materials and Methods Six patients with gastric SMTs very close to the EGJ underwent ELFR with laparoscopic two-layer suturing at Kyungpook National University Medical Center. With the patient under general anesthesia, the lesser curvature and posterior aspect adjacent to the EGJ were meticulously dissected and visualized using a laparoscopic approach. A partially circumferential full-thickness incision at the distal margin of the tumor was then made using an endoscopic approach under laparoscopic guidance. The SMT was resected using laparoscopic ultrasonic shears, and the gastric wall was closed using two-layer suturing. Thereafter, the patency and any leakage were checked through endoscopy. Results All the ELFR procedures with laparoscopic two-layer suturing were performed successfully without an open conversion. The mean operation time was 139.2±30.9 minutes and the blood loss was too minimal to be measured. The tumors from four patients were leiomyomas, while the tumors from the other two patients were gastrointestinal stromal tumors with clear resection margins. All the patients started oral intake on the third postoperative day. There was no morbidity or mortality. The mean hospital stay was 7.7±0.8 days. Conclusions ELFR with laparoscopic two-layer suturing is a safe treatment option for patients with an SMT close to the EGJ, as major resection of the stomach is avoided.
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Affiliation(s)
- Oh Kyoung Kwon
- Gastric Cancer Center, Kyungpook National University Medical Center, Daegu, Korea
| | - Wansik Yu
- Gastric Cancer Center, Kyungpook National University Medical Center, Daegu, Korea
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Yang F, Wang S, Sun S, Liu X, Ge N, Wang G, Guo J, Liu W, Feng L, Ma W. Factors associated with endoscopic full-thickness resection of gastric submucosal tumors. Surg Endosc 2015; 29:3588-3593. [PMID: 25894443 PMCID: PMC4648854 DOI: 10.1007/s00464-015-4113-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 02/13/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To identify factors that impact the procedure and treatment outcomes for endoscopic full-thickness resection (EFTR) of gastric submucosal tumors (SMTs). METHODS Medical records were collected for all patients with gastric SMTs who underwent EFTR procedures in Shengjing Hospital between June 2012 and April 2014. The data from each patient were reviewed, including gender, age, maximum tumor size on endoscopic ultrasound (EUS), tumor location in stomach, length of EFTR procedure, pneumoperitoneum during EFTR, cost to close defects, length of hospital stay after the procedure, and procedure-related complications. RESULTS Endoscopic full-thickness resection of gastric SMTs was successfully performed in all 41 patients. Maximum size on EUS [parameter estimate (PE) = 4.443, 95% confidence interval (CI) 2.191-6.695; p = 0.000] and tumor location in the greater curvature (PE = 44.441, 95% CI 5.539-83.343; p = 0.026) were significantly associated with the length of the procedure. A pneumoperitoneum was more likely to occur during EFTR in tumors with a larger EUS size [odds ratio (OR) = 1.415, 95% CI 1.034-1.936; p = 0.03], and less likely to occur during EFTR for tumors located in the posterior wall (OR = 0.003, 95% CI 0-0.351; p = 0.017). The use of the over-the-scope clip (OTSC) system was significantly associated with shorter hospital stays (PE = -1.006, 95% CI -1.998 to -0.014; p = 0.047) and a higher cost of closing defects (PE = 854.742, 95% CI 358.377-1351.107; p = 0.001). CONCLUSIONS Endoscopic full-thickness resection is an effective and safe method for removing gastric SMTs. Tumor size on EUS and location of the tumor were associated with the duration of EFTR and the occurrence of a pneumoperitoneum during the procedure. The use of an OTSC system was significantly associated with shorter hospital stays and a higher cost of closing defects.
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Affiliation(s)
- Fei Yang
- Endoscopic Center, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, 110004, Liaoning, China.
| | - Sheng Wang
- Endoscopic Center, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, 110004, Liaoning, China
| | - Siyu Sun
- Endoscopic Center, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, 110004, Liaoning, China.
| | - Xiang Liu
- Endoscopic Center, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, 110004, Liaoning, China
| | - Nan Ge
- Endoscopic Center, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, 110004, Liaoning, China
| | - Guoxin Wang
- Endoscopic Center, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, 110004, Liaoning, China
| | - Jintao Guo
- Endoscopic Center, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, 110004, Liaoning, China
| | - Wen Liu
- Endoscopic Center, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, 110004, Liaoning, China
| | - Linlin Feng
- Endoscopic Center, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, 110004, Liaoning, China
| | - Wenzhuang Ma
- Endoscopic Center, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, 110004, Liaoning, China
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Ntourakis D, Mavrogenis G. Cooperative laparoscopic endoscopic and hybrid laparoscopic surgery for upper gastrointestinal tumors: Current status. World J Gastroenterol 2015; 21:12482-12497. [PMID: 26604655 PMCID: PMC4649131 DOI: 10.3748/wjg.v21.i43.12482] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 09/15/2015] [Accepted: 10/17/2015] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the cooperative laparoscopic and endoscopic techniques used for the resection of upper gastrointestinal tumors. METHODS A systematic research of the literature was performed in PubMed for English and French language articles about laparoscopic and endoscopic cooperative, combined, hybrid and rendezvous techniques. Only original studies using these techniques for the resection of early gastric cancer, benign tumors and gastrointestinal stromal tumors of the stomach and the duodenum were included. By excluding case series of less than 10 patients, 25 studies were identified. The study design, number of cases, tumor pathology size and location, the operative technique name, the endoscopy team and surgical team role, operative time, type of closure of visceral wall defect, blood loss, complications and length of hospital stay of these studies were evaluated. Additionally all cooperative techniques found were classified and are presented in a systematic approach. RESULTS The studies identified were case series and retrospective cohort studies. A total of 706 patients were operated on with a cooperative technique. The tumors resected were only gastrointestinal stromal tumors (GIST) in 4 studies, GIST and various benign submucosal tumors in 22 studies, early gastric cancer (pT1a and pT1b) in 6 studies and early duodenal cancer in 1 study. There was important heterogeneity between the studies. The operative techniques identified were: laparoscopic assisted endoscopic resection, endoscopic assisted wedge resection, endoscopic assisted transgastric and intragastric surgery, laparoscopic endoscopic cooperative surgery (LECS), laparoscopic assisted endoscopic full thickness resection (LAEFR), clean non exposure technique and non-exposed endoscopic wall-inversion surgery (NEWS). Each technique is illustrated with the roles of the endoscopic and laparoscopic teams; the indications, characteristics and short term results are described. CONCLUSION Along with the traditional cooperative techniques, new procedures like LECS, LAEFR and NEWS hold great promise for the future of minimally invasive oncologic procedures.
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Mino JS, Guerron AD, Monteiro R, El-Hayek K, Ponsky JL, Patil DT, Walsh RM. Long-term outcomes of combined endoscopic/laparoscopic intragastric enucleation of presumed gastric stromal tumors. Surg Endosc 2015; 30:1747-53. [PMID: 26275537 DOI: 10.1007/s00464-015-4416-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 07/06/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE Definitive surgical treatment of gastric myogenic neoplasms such as gastrointestinal stromal tumors (GISTs) typically involves full-thickness resection of the lesion with normal gastric wall as the margin. This is not readily possible with proximal gastric lesions near the gastroesophageal junction, nor necessary for small incidental lesions. We have employed a combined endoscopic/laparoscopic intraluminal enucleation technique for selected patients and report long-term surveillance following this novel technique. METHODS Retrospective review of patients who have undergone intraluminal laparoscopic resection from 1994 to 2008. RESULTS Fifteen patients who underwent intraluminal enucleation were followed up for a median of 61 months. There were eight men and seven women with a mean age of 62.1 ± 3.38 years. Eight patients (53 %) underwent endoscopy for gastrointestinal bleeding, six for dyspepsia (40 %), six for anemia (40 %), and four for abdominal pain (27 %). Eight lesions (53 %) were located in the fundus/cardia: six (40 %) in the body and two (13 %) in the antrum. The mean tumor size was 3.5 ± 0.45 (1.5-7.0) cm. GIST lesions with benign histologic features predominated. All operations were successfully completed, including full-thickness resections with no conversion to open procedure, major morbidity, or mortality. Complete endoscopic and endosonographic surveillance was accomplished in 14 patients with no local or distant recurrence and no symptomatic follow-up in any patient. CONCLUSION Enucleation of intact gastrointestinal stromal tumors can be accomplished with low risk of recurrence when done with a combined endoscopic/laparoscopic intraluminal technique. It should be the preferred approach considered for small, proximal, intraluminal tumors.
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Affiliation(s)
- Jeffrey S Mino
- Department of General Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Alfredo D Guerron
- Department of General Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Rosebel Monteiro
- Department of General Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Kevin El-Hayek
- Department of General Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.,Department of General Surgery, Cleveland Clinic Foundation, Abu Dhabi, United Arab Emirates
| | - Jeffrey L Ponsky
- Department of General Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Deepa T Patil
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - R Matthew Walsh
- Department of General Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Kanehira E, Kamei A, Umezawa A, Kurita A, Tanida T, Nakagi M. Long-term outcomes of percutaneous endoscopic intragastric surgery in the treatment of gastrointestinal stromal tumors at the esophagogastric junction. Surg Endosc 2015. [DOI: 10.1007/s00464-015-4439-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Vinnicombe Z, Little M, Wan A. Laparo-endoscopic combined approach for excision of gastrointestinal stromal tumour close to the oesophagogastric junction. J Surg Case Rep 2015; 2015:rjv079. [PMID: 26157053 PMCID: PMC4495380 DOI: 10.1093/jscr/rjv079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Tumours close to the oesophagogastric junction (OGJ) are difficult to excise due to high risk of complications. Laparoscopic and endoscopic combined surgery allows minimally invasive access while increasing tumour visualization. Computed tomography (CT) scanning of a 68-year-old female demonstrated a lesion suspicious of a gastrointestinal stromal tumour located 2 cm from the OGJ on the posterior gastric wall. Stapled excision was performed intragastrically and followed by endoscopic removal. Gastroscopy 7 months post-op and follow-up CT scan at 5 years demonstrated no recurrence of the primary tumour and no new disease. Laparoscopic and endoscopic combined approach is a safe and effective method of removing tumours close to the OGJ.
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Affiliation(s)
- Zak Vinnicombe
- Department of Upper GI and Laparoscopic Surgery, St. George's Hospital, London, UK
| | - Max Little
- Department of Upper GI and Laparoscopic Surgery, St. George's Hospital, London, UK
| | - Andrew Wan
- Department of Upper GI and Laparoscopic Surgery, St. George's Hospital, London, UK
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Lamm SH, Steinemann DC, Linke GR, Eucker D, Simon T, Zerz A, Stoll R. Total inverse transgastric resection with transoral specimen removal. Surg Endosc 2014; 29:3363-6. [PMID: 25539694 DOI: 10.1007/s00464-014-4037-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 11/05/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Laparoscopic local excision is accepted for gastrointestinal stromal tumors (GIST) and benign lesions of the stomach. Yet, tumors at the gastroesophageal junction, on the posterior wall, or in the distal antrum are difficult to approach. Such tumors often must be exposed via gastrotomy or using a rendezvous maneuver. Our method of total intragastric laparoscopic resection using 'pneumogastrum', rigid laparoscope, and conventional laparoscopic instruments is described in an intuitive video. METHODS Two cases of total inverse transgastric resection involved resection of a submucosal GIST, one at the front wall of the cardia and the other on the posterior wall of the antrum. The third case required excision of a large prepyloric cystic lesion leading to a gastric outlet stenosis. After insertion of three trocars under laparoscopic control, a further trocar was introduced into the stomach and 'pneumogastrum' was established. Two additional 5-mm trocars were intragastrally placed. Intragastric endoscopy with a rigid optic provided an excellent view. The tumor was exposed resected with a linear stapler. The specimen was inserted into an Endo Pouch™ which was sutured to an orally inserted gastric tube. The Endo Pouch™ was gently pulled transorally. After removal of the intragastric trocars, the entrance points were laparoscopically closed. RESULTS From the first and second cases, we retrieved GIST tumors. In the third case, we retrieved a gastritis cystica profunda. Postoperative course was uneventful. CONCLUSIONS Gastric GIST should be resected laparoscopically if negative margins are safely achieved regardless of its size. Tumors at the frontwall and exophytic backwall GIST are addressed by laparoscopic wedge resection. Tumors at the gastrojejunal junction, in the prepyloric region, and fundus as well as submucous GIST of the gastric backwall are best approached by intragastric laparoscopic resection. Transoral specimen retrieval is an interesting option in smaller tumors.
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Affiliation(s)
- Sebastian H Lamm
- Department of Surgery, Kantonsspital Baselland, 4101, Bruderholz, Switzerland.
| | - Daniel C Steinemann
- Department of Surgery, Kantonsspital Baselland, 4101, Bruderholz, Switzerland.
| | - Georg R Linke
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Dietmar Eucker
- Department of Surgery, Kantonsspital Baselland, 4101, Bruderholz, Switzerland
| | - Thomas Simon
- Department of General and Visceral Surgery, Klinik Sinsheim, Alte Weibstadter Strasse 2, 74889, Sinsheim, Germany
| | - Andreas Zerz
- Department of Surgery, Kantonsspital Baselland, 4101, Bruderholz, Switzerland
| | - Reinhard Stoll
- Department of Surgery, Kantonsspital Baselland, 4101, Bruderholz, Switzerland
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18
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Barajas-Gamboa JS, Acosta G, Savides TJ, Sicklick JK, Fehmi SMA, Coker AM, Green S, Broderick R, Nino DF, Harnsberger CR, Berducci MA, Sandler BJ, Talamini MA, Jacobsen GR, Horgan S. Laparo-endoscopic transgastric resection of gastric submucosal tumors. Surg Endosc 2014; 29:2149-57. [PMID: 25303921 DOI: 10.1007/s00464-014-3910-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 09/18/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Laparoscopic and endoluminal surgical techniques have evolved and allowed improvements in the methods for treating benign and malignant gastrointestinal diseases. To date, only case reports have been reported on the application of a laparo-endoscopic approach for resecting gastric submucosal tumors (SMT). In this study, we aimed to evaluate the efficacy, safety, and oncologic outcomes of a laparo-endoscopic transgastric approach to resect tumors that would traditionally require either a laparoscopic or open surgical approach. Herein, we present the largest single institution series utilizing this technique for the resection of gastric SMT in North America. METHODS We performed a retrospective review of a prospectively collected patient database. Patients who presented for evaluation of gastric SMT were offered this surgical procedure and informed consents were obtained for participation in the study. RESULTS Fourteen patients were included in this study between August/2010 and January/2013. Eight (8) patients (57.1 %) were female and the median age was 56 years (range 29-78). Of the 14 cases, 8 patients (57.1 %) underwent laparo-endoscopic resection of SMTs with transgastric extraction, 5 patients (35.7 %) had conversions to traditional laparoscopic surgery, and 1 patient (7.2 %) was abandoned intraoperatively. The median operative time for this cohort was 80 min (range 35-167). Ten patients (71.4 %) had GISTs, 3 (21.4 %) had leiomyomas, and 1 (7.1 %) had schwannoma. There were no intraoperative complications. Two patients had postoperative staple line bleeding that required repeat endoscopy. The median hospital stay was 1 day (range 1-6) and there were no postoperative mortalities. At 12-month follow-up visit, only one GIST patient (10 %) had tumor recurrence. CONCLUSION Our experience suggests that this surgical approach is safe and efficient in the resection of gastric SMT with transgastric extraction. This study found no intraoperative complications and optimal oncologic outcomes during the follow-up period. Minimally invasive surgical approaches are emerging as a valid and potentially better approach for resecting malignancies; however, continued investigation is underway to further validate this data.
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Affiliation(s)
- Juan S Barajas-Gamboa
- Center for the Future of Surgery, University of California at San Diego, 9500 Gilman Drive La Jolla, San Diego, CA, 92093, USA,
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19
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Lee CM, Kim HH. Minimally invasive surgery for submucosal (subepithelial) tumors of the stomach. World J Gastroenterol 2014; 20:13035-13043. [PMID: 25278697 PMCID: PMC4177482 DOI: 10.3748/wjg.v20.i36.13035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 03/12/2014] [Accepted: 05/29/2014] [Indexed: 02/07/2023] Open
Abstract
Minimally invasive surgery has become common in the surgical resection of gastrointestinal submucosal tumors (SMTs). The purpose of this article is to review recent trends in minimally invasive surgery for gastric SMTs. Although laparoscopic resection has been main stream of minimally invasive surgery for gastrointestinal SMTs, recent advances in endoscopic procedures now provide various treatment modalities for gastric SMTs. Moreover, investigators have developed several hybrid techniques that include the advantages of both laparoscopic and endoscopic procedure. In addition, several types of reduced port surgeries, modification of conventional laparoscopic procedures, have been recently applied to the surgical resection of SMTs. Meanwhile, robotic surgery for SMTs requires further evidence and improvement.
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20
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Connor C, Pullatt R. Laparoscopic Transgastric Resection of a Gastric Polyp. Am Surg 2014. [DOI: 10.1177/000313481408000903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Chelsea Connor
- Department of Surgery Medical University of South Carolina Charleston, South Carolina
| | - Rana Pullatt
- Department of Surgery Medical University of South Carolina Charleston, South Carolina
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21
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Conrad C, Nedelcu M, Ogiso S, Aloia TA, Vauthey JN, Gayet B. Techniques of intragastric laparoscopic surgery. Surg Endosc 2014; 29:202-6. [PMID: 25106714 DOI: 10.1007/s00464-014-3654-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 11/22/2013] [Indexed: 12/13/2022]
Abstract
Benign or pre-cancerous lesions and foreign bodies of the stomach not amendable to endoscopic removal often require extensive surgery to address a process that does not necessitate lymph node sampling or formal gastrectomy. These lesions are particularly difficult to address endoscopically when located at the esophagogastric junction as a retroflexed view is needed. From its first description in 1995, intragastric laparoscopic surgery has evolved with respect to both technological advancements and tactical innovations. Here we report the development of four distinct techniques of laparoscopic intragastric surgery which we have developed over time and applied in 11 patients. These techniques consist of a (1) combined gastroscopic/laparoscopic approach when minimal manipulation of the lesion is needed, (2) multiport resection which provides optimal triangulation and allows for resection of more complex lesions, (3) stapled removal of broad-based lesions, and (4) single access technique with the device placed directly through the abdominal wall into the stomach. The techniques expand the surgeon's armamentarium to address more complex intragastric processes safely, while the typical postoperative benefits of minimal access surgery such as fast recovery time and less pain are preserved. As we gain greater experience with intragastric laparoscopic surgery, this technique holds the promise of becoming a standard surgical technique for benign lesions for which it is oncologically safe to perform a limited resection.
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Affiliation(s)
- Claudius Conrad
- Institute Mututaliste Montsouris, University of Paris Descartes, Paris, France,
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22
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Ko SY, Lee JS, Kim JJ, Park SM. Higher incidence of gastroesophageal reflux disease after gastric wedge resections of gastric submucosal tumors located close to the gastroesophageal junction. Ann Surg Treat Res 2014; 86:289-94. [PMID: 24949319 PMCID: PMC4062447 DOI: 10.4174/astr.2014.86.6.289] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/06/2014] [Accepted: 02/12/2014] [Indexed: 12/14/2022] Open
Abstract
Purpose We hypothesized that gastroesophageal reflux disease (GERD) would be more prevalent after a gastric wedge resection of a submucosal tumor (SMT) located close to the gastroesophageal junction (GEJ) than after a gastric wedge resection of an SMT at other locations because of the damage to the lower esophageal sphincter during surgery. Methods Fifty-eight patients with gastric SMT who underwent open or laparoscopic gastric wedge resection between January 2000 and August 2012 at the Department of Surgery, Incheon St. Mary's Hospital were enrolled into this study. The patients were divided into 2 groups according to the location of the tumor, upper or lateral border of the tumor within 5 cm of the GEJ (GEJ ≤ 5 cm group) and upper or lateral border of the tumor greater than 5 cm distal to the GEJ (GEJ > 5 cm group). The surgical records, clinicopathologic findings, postoperative GERD symptoms, postoperative use of acid suppressive medications and preoperative and postoperative endoscopic findings were retrospectively reviewed and compared between the 2 groups. Results There was no difference in the frequency of the preoperative GERD symptoms between the 2 groups, whereas postoperative GERD symptoms and postoperative use of acid suppressive medications were more frequent in the GEJ ≤ 5 cm group (P = 0.045 and P = 0.031). However, there were no differences in the follow-up endoscopic findings in terms of reflux esophagitis and Hill's grade between the 2 groups. Conclusion The incidence of GERD was higher after gastric wedge resection of SMTs located close to the GEJ. Hence, adequate care should be taken during the follow-up of these patients.
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Affiliation(s)
- Seung Yeon Ko
- Division of Gastrointestinal Surgery, Department of Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Incheon, Korea
| | - Jeong Sun Lee
- Division of Gastrointestinal Surgery, Department of Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Incheon, Korea
| | - Jin-Jo Kim
- Division of Gastrointestinal Surgery, Department of Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Incheon, Korea
| | - Seung-Man Park
- Division of Gastrointestinal Surgery, Department of Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Incheon, Korea
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23
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Fukami N. What we want for ESD is a second hand! Traction method. Gastrointest Endosc 2013; 78:274-6. [PMID: 23867374 DOI: 10.1016/j.gie.2013.04.192] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 04/28/2013] [Indexed: 02/08/2023]
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24
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Sun C, He Z, Zheng Z, Yu Q, Wang T, Liu W, Wang B. Endoscopic submucosal dissection for gastrointestinal mesenchymal tumors adjacent to the esophagogastric junction: we need to do more. J Laparoendosc Adv Surg Tech A 2013; 23:570-7. [PMID: 23631665 DOI: 10.1089/lap.2012.0462] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Extensive surgery is the mainstay of therapy for patients with gastrointestinal mesenchymal tumors (GIMTs) adjacent to the esophagogastric junction (EGJ). However, this modality is invasive and may interfere with anatomic consistency of the digestive tract. Therefore, we evaluated the feasibility, safety, and efficacy of endoscopic submucosal dissection (ESD) for GIMTs close to the EGJ and factors related to incomplete resection. PATIENTS AND METHODS For 39 GIMTs adjacent to the EGJ in 39 consecutive patients, the baseline information, complications, and therapeutic outcomes were recorded. Subsequently, risk factors, focusing on age, sex, tumor size, extent, shape, perforation presence/absence, and histopathology, were analyzed. RESULTS Complete removal of junctional GIMTs was achieved in 32 cases, giving an overall complete resection rate of 82%. The mean tumor size was 16.1±12.7 (median, 12; range, 4-50) mm. There were no major intra- and postoperative complications, but two small perforations were found. The final histopathologic diagnoses included 28 leiomyomas, 10 gastrointestinal stromal tumors, and 1 schwannoma. No local recurrence or distant metastasis was observed during a mean follow-up of 15.7±8.4 (median, 16; range, 6-35) months. Univariate analysis showed incomplete resection was associated with tumor shape and size. Multivariate regression analysis identified tumor irregularity (odds ratio=37.50, 95% confidence interval=4.253-330.627) as the single factor associated with incomplete resection. CONCLUSIONS ESD is feasible and safe for well-selected patients with GIMTs adjacent to the EGJ. Irregular tumor shape should be considered as a technical difficulty while performing ESD. Oncologic outcomes need to be assessed with longer follow-up.
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Affiliation(s)
- Chao Sun
- Department of Digestive Diseases, General Hospital, Tianjin Medical University, Tianjin, China
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25
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Kong SH, Yang HK. Surgical treatment of gastric gastrointestinal stromal tumor. J Gastric Cancer 2013; 13:3-18. [PMID: 23610714 PMCID: PMC3627804 DOI: 10.5230/jgc.2013.13.1.3] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 03/09/2013] [Accepted: 03/10/2013] [Indexed: 12/13/2022] Open
Abstract
Gastrointestinal stromal tumor is the most common mesenchymal tumor in the gastrointestinal tract and is most frequently developed in the stomach in the form of submucosal tumor. The incidence of gastric gastrointestinal stromal tumor is estimated to be as high as 25% of the population when all small and asymptomatic tumors are included. Because gastric gastrointestinal stromal tumor is not completely distinguished from other submucosal tumors, a surgical excisional biopsy is recommended for tumors >2 cm. The surgical principles of gastrointestinal stromal tumor are composed of an R0 resection with a normal mucosa margin, no systemic lymph node dissection, and avoidance of perforation, which results in peritoneal seeding even in cases with otherwise low risk profiles. Laparoscopic surgery has been indicated for gastrointestinal stromal tumors <5 cm, and the indication for laparoscopic surgery is expanded to larger tumors if the above mentioned surgical principles can be maintained. A simple exogastric resection and various transgastric resection techniques are used for gastrointestinal stromal tumors in favorable locations (the fundus, body, greater curvature side). For a lesion at the gastroesophageal junction in the posterior wall of the stomach, enucleation techniques have been tried preserve the organ's function. Those methods have a theoretical risk of seeding a ruptured tumor, but this risk has not been evaluated by well-designed clinical trials. While some clinical trials are still on-going, neoadjuvant imatinib is suggested when marginally unresectable or multiorgan resection is anticipated to reduce the extent of surgery and the chance of incomplete resection, rupture or bleeding.
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Affiliation(s)
- Seong-Ho Kong
- Department of Surgery, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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26
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Liao YT, Yang CY, Lai IR, Chen CN, Lin MT. Laparoscopic Resection for Submucosal Tumors Near the Esophagogastric Junction. Surg Innov 2012; 20:478-83. [DOI: 10.1177/1553350612469281] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background. Minimally invasive surgery has proved to be effective and efficient in the management of gastric submucosal tumors (SMT). However, confronting a SMT near the esophagogastric junction (EGJ) is still challenging because of the potentially devastating risks of stenosis or leakage. This study evaluated the safety, feasibility, and oncological efficacy of laparoscopic resection for SMTs located near the EGJ. Methods. From December 2008 to November 2011, we enrolled a total of 19 patients diagnosed with gastric SMTs located near the EGJ who underwent laparoscopic surgery. The clinicopathological characteristics and surgical outcomes of the 19 patients were recorded and reviewed retrospectively. Results. All 19 patients underwent laparoscopic resections of their gastric SMTs without complications during the study period. There were 9 men and 10 women, with a mean age of 63.3 ± 15.1 years (range 33-86 years). The operative duration was 187.8 ± 58.9 minutes (range 90-310 minutes). Intraoperative localization included endoscopy (n = 3), tattooing (n = 2), and combined modalities (n = 1). The exogastric (n = 12) and transgastric methods (n = 7) were used. The histopathology showed 10 gastrointestinal stromal tumors, 7 leiomyomas, 1 hyperplastic polyp, and 1 lipoma. The postoperative courses for all cases were uneventful. The mean follow-up period was 16.7 ± 9.4 months, with no recurrence noted. Conclusions: Laparoscopic resections for gastric SMTs near the EGJ are safe and feasible, with satisfactory oncological outcomes in the short term.
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Affiliation(s)
- Yu-Tso Liao
- National Taiwan University Hospital, Taipei, Taiwan
| | | | - I-Ru Lai
- National Taiwan University Hospital, Taipei, Taiwan
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27
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Willingham FF, Garud SS, Davis SS, Lewis MM, Maithel SK, Kooby DA. Human hybrid endoscopic and laparoscopic management of mass lesions of the foregut (with video). Gastrointest Endosc 2012; 75:905-12. [PMID: 22281108 DOI: 10.1016/j.gie.2011.11.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 11/17/2011] [Indexed: 12/29/2022]
Affiliation(s)
- Field F Willingham
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia 30322, USA
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28
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Na JU, Lee SI, Noh SM. The single incision laparoscopic intragastric wedge resection of gastric submucosal tumor. J Gastric Cancer 2011; 11:225-9. [PMID: 22324014 PMCID: PMC3273693 DOI: 10.5230/jgc.2011.11.4.225] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Revised: 10/16/2011] [Accepted: 10/25/2011] [Indexed: 12/16/2022] Open
Abstract
Purpose Laparoscopic wedge resection of gastric submucosal tumor may be difficult in case of the endophytic mass or the mass located unreachable area such as cardia, and intragastric approach can be useful. We would present the experiences of the intragastric wedge resection. Materials and Methods There were 7 patients diagnosed as gastric submucosal tumor and underwent the intragastric wedge resection at Surgery, Chungnam National University Hospital. We reviewed medical record. Results There were 3 male and 4 female. Mean age was 65 years-old (57~73). Mean body mass index was 26.28 kg/m2 (21.28~35.30). Location of lesions was 4 cardia, 2 fundus and 1 midbody, respectively. Mean operation time was 83.6 minutes (70~105). All patients were healed without any complication. Mean postoperative hospital stay was 5.4 days (4~6). Mean size was 2.7 cm (2.3~3.8). Pathologic finding was 5 gastrointestinal stromal tumor and 2 leiomyoma. Conclusions The single incision intragastric wedge resection of gastric submucosal tumor is feasible and acceptable, especially in mass of gastric upper part.
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Affiliation(s)
- Jin-Uk Na
- Department of Surgery, Chungnam National University School of Medicine, Daejeon, Korea
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29
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Bona D, Aiolfi A, Siboni S, Bernardi D, Bonavina L. Giant leiomyoma of the gastroesophageal junction: technique and results of endoscopic full-thickness resection. Clin Exp Gastroenterol 2011; 4:263-7. [PMID: 22235168 PMCID: PMC3254202 DOI: 10.2147/ceg.s26119] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Four consecutive patients with a giant leiomyoma originating from the posterior aspect of the gastroesophageal junction were treated with full-thickness endoscopic retroflex dissection. A complete removal of the lesion was obtained in all cases. No complications were observed except for some degree of air filtration causing symptomatic pneumoperitoneum in one patient. Retroflex endoscopic full-thickness resection of giant leiomyoma at the gastroesophageal junction is feasible and safe.
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Affiliation(s)
- Davide Bona
- Department of Surgery, IRCCS Policlinico San Donato, University of Milano School of Medicine, Milano, Italy
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30
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Lee JS, Kim JJ, Park SM. Laparoscopic gastric wedge resection and prophylactic antireflux surgery for a submucosal tumor of gastroesophageal junction. J Gastric Cancer 2011; 11:131-4. [PMID: 22076215 PMCID: PMC3204491 DOI: 10.5230/jgc.2011.11.2.131] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 06/13/2011] [Indexed: 11/20/2022] Open
Abstract
A laparoscopic wedge resection for a submucosal tumor, which is close to the gastroesophageal junction, is technically challenging. This can be a dilemma to both patients and surgeons when the tumor margin involves the gastroesophageal junction because a wedge resection in this situation might result in a deformity of the gastroesophageal junction or an injury to the lower esophageal sphincter, which ultimately results in lifelong gastroesophageal reflux disease. The patient was a 42 year-old male, whose preoperative endoscopic ultrasonographic finding did not rule out a gastrointestinal stromal tumor. He underwent a laparoscopic gastric wedge resection and prophylactic anterior partial fundoplication (Dor) and was discharged from hospital on the fifth postoperative day without any complications. There were no symptoms of reflux 5 months after surgery. A laparoscopic wedge resection and prophylactic anti-reflux surgery might be a good surgical option for a submucosal tumor at the gastroesophageal junction.
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Affiliation(s)
- Jeong Sun Lee
- Department of Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea, School of Medicine, Incheon, Korea
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