Original Article

J Minim Invasive Surg 2012; 15(4): 106-113

Published online December 15, 2012

https://doi.org/10.7602/jmis.2012.15.4.106

© The Korean Society of Endo-Laparoscopic & Robotic Surgery

Laparoscopic Resection of Gastric Submucosal Tumors: Outcomes of 141 Consecutive Cases in a Single Center

Keesang Yoo, M.D., Hoon Hur, M.D., Cheul Su Byun, M.D., Yi Xian, M.D., Sang-Uk Han, M.D., Yong Kwan Cho, M.D.

Department of Surgery, Ajou University School of Medicine, Suwon, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Purpose: The treatment of choice for gastric submucosal tumors (SMT) is surgical resection. Recent advanced techniques has facilitated more extensive application of laparoscopic surgery to most types of resectable gastric SMTs. The aim of this study was to verify the efficacy of laparoscopic resection for treatment of gastric SMT through analysis of outcomes obtained at a single center.
Methods: A total of 141 patients who underwent laparoscopic resection for treatment of gastric SMT were enrolled between April 2003 and June 2011. Analysis of the demographics, tumor characteristics, and surgical or oncological outcomes of these patients was performed.
Results: Gastrointestinal stromal tumors (GIST) were the most common pathologic findings (90 cases), and the upper third of the stomach was the most common location (70 cases). Wedge resections were performed in 128 patients and major gastrectomies were performed in 13 patients. The mean surgical time was 102 minutes, which was reduced to a stable 70 minutes after the 30th case. The surgical time for tumors located on the posterior or lesser portion of the upper third of the stomach was longer than that for other lesions. Twelve postoperative complications, including two cases of intra-abdominal bleeding, one case of marginal ulcer bleeding, and one case of leakage occurred. However, there was no occurrence of complications after the 70th case. During the follow-up period, two patients suffered recurrent GIST.
Conclusion: Laparoscopic surgery for treatment of gastric SMT is safe and feasible, particularly as the surgeon develops greater skill with increased experience. Laparoscopic resection is useful for treatment of any type of gastric SMT.

Keywords Submucosal tumor, Laparoscopy, Gastric neoplasm

  1. Kim CJ, Day S, Yeh KA. Gastr ointestinal stromal tumors:analysis of clinical and pathologic factors. Am Surg 2001;67:135-137.
    Pubmed
  2. Iwahashi M, Takifuji K, Ojima T, et al. Surgical management of small gastrointestinal stromal tumors of the stomach. World J Surg 2006;30:28-35.
    Pubmed CrossRef
  3. Berindoague R, Targarona EM, Feliu X, et al. Laparoscopic resection of clinically suspecte d gastric stromal tumors. Surg Innov 2006;13:231-237.
    Pubmed CrossRef
  4. Matthews BD, Walsh RM, Kercher KW, et al. Laparoscopic vs open resection of gastric stromal tumors. Surg Endosc 2002;16:803-807.
    Pubmed CrossRef
  5. Roukos DH. Current advances and changes in treatment strategy may improve survival an d quality of life in patients with potentially curable gastric cancer. Ann Surg Oncol 1999;6:46-56.
    Pubmed CrossRef
  6. Heinrich MC, Corless CL. Gastric GI stromal tumors (GISTs):the role of surgery in the era of targeted therapy. J Surg Onco l 2005;90:195-207.
    Pubmed CrossRef
  7. Demetri GD, Benjamin RS, Blanke CD, et al. NCCN Task Force report: management of pa tients with gastrointestinal stromal tumor (GIST)--update o f the NCCN clinical practice guidelines. J Natl Compr Canc Netw 5 Suppl 2007;2:S1-29.
  8. Karakousis GC, Singer S, Zheng J, et al. Laparoscopic versus open gastric resections for primary gastrointestinal stromal tumors (GISTs): a size-matched comparison. Ann Surg Oncol 2011;18:1599-1605.
    Pubmed CrossRef
  9. Nishimura J, Nakajima K, Omori T, et al. Surgical strategy for gastric gastrointestinal stromal tumors: laparoscopic vs. open resection. Surg Endosc 2007;21:875-878.
    Pubmed CrossRef
  10. Novitsky YW, Kercher KW, Sing RF, et al. Long-term outcomes of laparoscopic resectio n of gastric gastrointestinal stromal tumors. Ann Surg 2006;243:738-745.
    Pubmed KoreaMed CrossRef
  11. De Vogelaere K, Van Loo I, Peters O, et al. Laparoscopic resection of gastric gastrointestinal stromal tumors (GIST) is safe and effective, irrespective of tumor size. Surg Endosc 2012;26:2339-2345.
    Pubmed CrossRef
  12. Hyung WJ, Lim JS, Cheong JH, et al. Laparoscopic resection of a huge intraluminal gastric s ubmucosal tumor located in the anterior wall: eversion method. J Surg Oncol 2005;89:95-98.
    Pubmed CrossRef
  13. Ishikawa K, Inomata M, Etoh T, et al. Long-term outcome of laparoscopic wedge resection f or gastric submucosal tumor compared with open wedge resection. Surg Laparosc Endosc Percutan Tech 2006;16:82-85.
    Pubmed CrossRef
  14. Cheng HL, Lee WJ, Lai IR, et al. Laparoscopic wedge resection of benign gastric tumor. Hepatogastroenterology 1999;46:2100-2104.
    Pubmed
  15. Shimizu S, Noshiro H, Nagai E, et al. Laparoscopic wedge resection of gastric submucosa l tumors. Dig Surg 2002;19:169-173.
    Pubmed CrossRef
  16. Otani Y, Furukawa T, Yoshida M, et al. Operative indications for relatively small (2-5 cm) gastrointestinal stromal tumor of the stomach based on analysis of 60 operated cases. Surgery 2006;139:484-492.
    Pubmed CrossRef
  17. Iizuka H, Kakizaki S, Sohara N, et al. Stricture after endoscopic submucosal dissecti on for early gastric cancers and adenomas. Dig Endosc 2010;22:282-288.
    Pubmed CrossRef
  18. Tsunada S, Ogata S, Mannen K, et al. Case series of endoscopic balloon dilation to treat a stricture caused by circumferential resection of the gastric antrum by endoscopic submucosal dissection. Gastr ointest Endosc 2008;67:979-983.
    Pubmed CrossRef
  19. Hwang SH, Park do J, Kim YH, et al. Laparoscopic surgery for submucosal tumors located a t the esophagogastric junction and the prepylorus. Surg Endosc 2009;23:1980-1987.
    Pubmed CrossRef
  20. Song KY, Kim SN, Park CH. Tailored-approach of laparoscopic wedge resection for treatment of submucosal tumor near the esophagogastric junction. S urg Endoc 2007;21:2272-2276.
    CrossRef
  21. Ibrahim IM, Silvestri F, Zingler B. Laparoscopic resection o f posterior gastric leiomyoma. Surg Endosco 1997;11:277-279.
    CrossRef
  22. Watson DI, Game PA, Devitt PG. Laparoscopic resection of benign tumors of the posterior gastric wall. Surg Endosc 1996;10:540-541. 23.DeMatteo RP, Lewis JJ, Leung D, et al. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 2000;231:51-58.
    CrossRef
  23. Ng EH, Pollock RE, Romsdahl MM. Prognostic implications of patterns of failure for gas trointestinal leiomyosarcomas. Cancer 1992;69:1334-1341.
    CrossRef
  24. Pierie JP, Choudry U, Muzikansky A, et al. The effect of surgery and grade on outcome of gastrointestinal stromal tumors. Arch Surg 2001;136:383-389.
    Pubmed CrossRef

Article

Original Article

J Minim Invasive Surg 2012; 15(4): 106-113

Published online December 15, 2012 https://doi.org/10.7602/jmis.2012.15.4.106

Copyright © The Korean Society of Endo-Laparoscopic & Robotic Surgery.

Laparoscopic Resection of Gastric Submucosal Tumors: Outcomes of 141 Consecutive Cases in a Single Center

Keesang Yoo, M.D., Hoon Hur, M.D., Cheul Su Byun, M.D., Yi Xian, M.D., Sang-Uk Han, M.D., Yong Kwan Cho, M.D.

Department of Surgery, Ajou University School of Medicine, Suwon, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose: The treatment of choice for gastric submucosal tumors (SMT) is surgical resection. Recent advanced techniques has facilitated more extensive application of laparoscopic surgery to most types of resectable gastric SMTs. The aim of this study was to verify the efficacy of laparoscopic resection for treatment of gastric SMT through analysis of outcomes obtained at a single center.
Methods: A total of 141 patients who underwent laparoscopic resection for treatment of gastric SMT were enrolled between April 2003 and June 2011. Analysis of the demographics, tumor characteristics, and surgical or oncological outcomes of these patients was performed.
Results: Gastrointestinal stromal tumors (GIST) were the most common pathologic findings (90 cases), and the upper third of the stomach was the most common location (70 cases). Wedge resections were performed in 128 patients and major gastrectomies were performed in 13 patients. The mean surgical time was 102 minutes, which was reduced to a stable 70 minutes after the 30th case. The surgical time for tumors located on the posterior or lesser portion of the upper third of the stomach was longer than that for other lesions. Twelve postoperative complications, including two cases of intra-abdominal bleeding, one case of marginal ulcer bleeding, and one case of leakage occurred. However, there was no occurrence of complications after the 70th case. During the follow-up period, two patients suffered recurrent GIST.
Conclusion: Laparoscopic surgery for treatment of gastric SMT is safe and feasible, particularly as the surgeon develops greater skill with increased experience. Laparoscopic resection is useful for treatment of any type of gastric SMT.

Keywords: Submucosal tumor, Laparoscopy, Gastric neoplasm

References

  1. Kim CJ, Day S, Yeh KA. Gastr ointestinal stromal tumors:analysis of clinical and pathologic factors. Am Surg 2001;67:135-137.
    Pubmed
  2. Iwahashi M, Takifuji K, Ojima T, et al. Surgical management of small gastrointestinal stromal tumors of the stomach. World J Surg 2006;30:28-35.
    Pubmed CrossRef
  3. Berindoague R, Targarona EM, Feliu X, et al. Laparoscopic resection of clinically suspecte d gastric stromal tumors. Surg Innov 2006;13:231-237.
    Pubmed CrossRef
  4. Matthews BD, Walsh RM, Kercher KW, et al. Laparoscopic vs open resection of gastric stromal tumors. Surg Endosc 2002;16:803-807.
    Pubmed CrossRef
  5. Roukos DH. Current advances and changes in treatment strategy may improve survival an d quality of life in patients with potentially curable gastric cancer. Ann Surg Oncol 1999;6:46-56.
    Pubmed CrossRef
  6. Heinrich MC, Corless CL. Gastric GI stromal tumors (GISTs):the role of surgery in the era of targeted therapy. J Surg Onco l 2005;90:195-207.
    Pubmed CrossRef
  7. Demetri GD, Benjamin RS, Blanke CD, et al. NCCN Task Force report: management of pa tients with gastrointestinal stromal tumor (GIST)--update o f the NCCN clinical practice guidelines. J Natl Compr Canc Netw 5 Suppl 2007;2:S1-29.
  8. Karakousis GC, Singer S, Zheng J, et al. Laparoscopic versus open gastric resections for primary gastrointestinal stromal tumors (GISTs): a size-matched comparison. Ann Surg Oncol 2011;18:1599-1605.
    Pubmed CrossRef
  9. Nishimura J, Nakajima K, Omori T, et al. Surgical strategy for gastric gastrointestinal stromal tumors: laparoscopic vs. open resection. Surg Endosc 2007;21:875-878.
    Pubmed CrossRef
  10. Novitsky YW, Kercher KW, Sing RF, et al. Long-term outcomes of laparoscopic resectio n of gastric gastrointestinal stromal tumors. Ann Surg 2006;243:738-745.
    Pubmed KoreaMed CrossRef
  11. De Vogelaere K, Van Loo I, Peters O, et al. Laparoscopic resection of gastric gastrointestinal stromal tumors (GIST) is safe and effective, irrespective of tumor size. Surg Endosc 2012;26:2339-2345.
    Pubmed CrossRef
  12. Hyung WJ, Lim JS, Cheong JH, et al. Laparoscopic resection of a huge intraluminal gastric s ubmucosal tumor located in the anterior wall: eversion method. J Surg Oncol 2005;89:95-98.
    Pubmed CrossRef
  13. Ishikawa K, Inomata M, Etoh T, et al. Long-term outcome of laparoscopic wedge resection f or gastric submucosal tumor compared with open wedge resection. Surg Laparosc Endosc Percutan Tech 2006;16:82-85.
    Pubmed CrossRef
  14. Cheng HL, Lee WJ, Lai IR, et al. Laparoscopic wedge resection of benign gastric tumor. Hepatogastroenterology 1999;46:2100-2104.
    Pubmed
  15. Shimizu S, Noshiro H, Nagai E, et al. Laparoscopic wedge resection of gastric submucosa l tumors. Dig Surg 2002;19:169-173.
    Pubmed CrossRef
  16. Otani Y, Furukawa T, Yoshida M, et al. Operative indications for relatively small (2-5 cm) gastrointestinal stromal tumor of the stomach based on analysis of 60 operated cases. Surgery 2006;139:484-492.
    Pubmed CrossRef
  17. Iizuka H, Kakizaki S, Sohara N, et al. Stricture after endoscopic submucosal dissecti on for early gastric cancers and adenomas. Dig Endosc 2010;22:282-288.
    Pubmed CrossRef
  18. Tsunada S, Ogata S, Mannen K, et al. Case series of endoscopic balloon dilation to treat a stricture caused by circumferential resection of the gastric antrum by endoscopic submucosal dissection. Gastr ointest Endosc 2008;67:979-983.
    Pubmed CrossRef
  19. Hwang SH, Park do J, Kim YH, et al. Laparoscopic surgery for submucosal tumors located a t the esophagogastric junction and the prepylorus. Surg Endosc 2009;23:1980-1987.
    Pubmed CrossRef
  20. Song KY, Kim SN, Park CH. Tailored-approach of laparoscopic wedge resection for treatment of submucosal tumor near the esophagogastric junction. S urg Endoc 2007;21:2272-2276.
    CrossRef
  21. Ibrahim IM, Silvestri F, Zingler B. Laparoscopic resection o f posterior gastric leiomyoma. Surg Endosco 1997;11:277-279.
    CrossRef
  22. Watson DI, Game PA, Devitt PG. Laparoscopic resection of benign tumors of the posterior gastric wall. Surg Endosc 1996;10:540-541. 23.DeMatteo RP, Lewis JJ, Leung D, et al. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 2000;231:51-58.
    CrossRef
  23. Ng EH, Pollock RE, Romsdahl MM. Prognostic implications of patterns of failure for gas trointestinal leiomyosarcomas. Cancer 1992;69:1334-1341.
    CrossRef
  24. Pierie JP, Choudry U, Muzikansky A, et al. The effect of surgery and grade on outcome of gastrointestinal stromal tumors. Arch Surg 2001;136:383-389.
    Pubmed CrossRef

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