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

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Laparoscopic wedge resection (LWR) is used to treat gastric submucosal tumors (SMTs). However, LWR can injure the cardia if tumors are near the esophagogastric junction (EGJ), resulting in gastric stenosis. This study’s purpose was to summarize our experience with endoscope-assisted LWR for gastric SMTs within 3 cm of the EGJ and to verify the procedure’s feasibility and safety.

Methods

Data from 91 consecutive patients with gastric SMTs within 3 cm of the EGJ who underwent endoscope-assisted LWR at our hospital from 2007 to 2017 were obtained from a prospectively maintained database. The clinicopathological results, perioperative data, and long-term follow-up data were analyzed.

Results

All patients successfully underwent endoscope-assisted LWR. The mean distance from tumor to EGJ was 2.43 ± 0.80 cm. Eighty-two patients underwent laparoscopic exogastric wedge resection (LEWR) and nine underwent laparoscopic transgastric wedge resection (LTWR). Mean operative time was 112.4 ± 48.8 min; mean blood loss was 36.8 ± 53.5 ml. Mean time to first flatus was 2.04 ± 0.68 days. Mean time to liquid intake was 2.53 ± 0.85 days. Mean postoperative hospital stay was 4.97 ± 1.80 days. Three patients (3.3%) had postoperative complications, all Clavien–Dindo grade I. The mean maximum tumor diameter was 3.00 ± 1.96 cm (range 0.5–10). LTWR was used more often than LEWR for SMTs in the posterior wall, those with intraluminal growth, and those closer to the EGJ. The mean follow-up time was 36.86 ± 29.73 months (range 3–126). There was no stenosis of EGJ or tumor recurrence. Sixteen patients (17.6%) complained of upper gastrointestinal symptoms during the follow-up, which were all relieved by usage of acid suppressive medications.

Conclusions

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.

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References

  1. Wiech T, Walch A, Werner M. Histopathological classification of nonneoplastic and neoplastic gastrointestinal submucosal lesions. Endoscopy 2005;37(7):630–4.

    Article  CAS  PubMed  Google Scholar 

  2. Ponsaing LG, Kiss K, Hansen MB. Classification of submucosal tumors in the gastrointestinal tract. World J Gastroenterol 2007;13(24):3311–5.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Hedenbro JL, Ekelund M, Wetterberg P. Endoscopic diagnosis of submucosal gastric lesions. The results after routine endoscopy. Surg Endosc 1991;5(1):20–3.

    Article  CAS  PubMed  Google Scholar 

  4. Matsuda T, Nunobe S, Kosuga T, Kawahira H, Inaki N, Kitashiro S, Abe N, Miyashiro I, Nagao S, Nishizaki M, Hiki N; Society for the Study of Laparoscopy and Endoscopy Cooperative Surgery. Laparoscopic and luminal endoscopic cooperative surgery can be a standard treatment for submucosal tumors of the stomach: a retrospective multicenter study. Endoscopy. 2017;49(5):476–483.

  5. Lee IL, Lin PY, Tung SY, Shen CH, Wei KL, Wu CS. Endoscopic submucosal dissection for the treatment of intraluminal gastric subepithelial tumors originating from the muscularis propria layer. Endoscopy. 2006;38(10):1024–8.

    Article  PubMed  Google Scholar 

  6. American Gastroenterological Association Institute. American Gastroenterological Association Institute medical position statement on the management of gastric subepithelial masses. Gastroenterology. 2006;130(7):2215–6.

    Article  Google Scholar 

  7. Shi Q, Zhong YS, Yao LQ, Zhou PH, Xu MD, Wang P. Endoscopic submucosal dissection for treatment of esophageal submucosal tumors originating from the muscularis propria layer. Gastrointest Endosc. 2011;74(6):1194–200.

    Article  PubMed  Google Scholar 

  8. Joensuu H, Fletcher C, Dimitrijevic S, Silberman S, Roberts P, Demetri G. Management of malignant gastrointestinal stromal tumours. Lancet Oncol. 2002;3(11):655–64.

    Article  CAS  PubMed  Google Scholar 

  9. De Vogelaere K, Hoorens A, Haentjens P, Delvaux G. Laparoscopic versus open resection of gastrointestinal stromal tumors of the stomach. Surg Endosc. 2013;27(5):1546–54.

    Article  PubMed  Google Scholar 

  10. Hu Y, Huang C, Sun Y, Su X, Cao H, Hu J, Xue Y, Suo J, Tao K, He X, Wei H, Ying M, Hu W, Du X, Chen P, Liu H, Zheng C, Liu F, Yu J, Li Z, Zhao G, Chen X, Wang K, Li P, **ng J, Li G. Morbidity and Mortality of Laparoscopic Versus Open D2 Distal Gastrectomy for Advanced Gastric Cancer: A Randomized Controlled Trial. J Clin Oncol. 2016;34(12):1350–7.

    Article  PubMed  Google Scholar 

  11. Correa-Cote J, Morales-Uribe C, Sanabria A. Laparoscopic management of gastric gastrointestinal stromal tumors. World J Gastrointest Endosc. 2014;6(7):296–303.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Choi SM, Kim MC, Jung GJ, Kim HH, Kwon HC, Choi SR, Jang JS, Jeong JS. Laparoscopic wedge resection for gastric GIST: long-term follow-up results. Eur J Surg Oncol. 2007;33(4):444–7.

    Article  PubMed  Google Scholar 

  13. Choi YB, Oh ST. Laparoscopy in the management of gastric submucosal tumors. Surg Endosc. 2000;14(8):741–5.

    Article  CAS  PubMed  Google Scholar 

  14. Liao YT, Yang CY, Lai IR, Chen CN, Lin MT. Laparoscopic resection for submucosal tumors near the esophagogastric junction: feasibility and short-term outcome. Surg Innov. 2013;20(5):478–83.

    Article  PubMed  Google Scholar 

  15. Xu X, Chen K, Zhou W, Zhang R, Wang J, Wu D, Mou Y. Laparoscopic transgastric resection of gastric submucosal tumors located near the esophagogastric junction. J Gastrointest Surg. 2013;17(9):1570–5.

    Article  PubMed  Google Scholar 

  16. 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(4):278–85.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Hoteya S, Haruta S, Shinohara H, Yamada A, Furuhata T, Yamashita S, Kikuchi D, Mitani T, Ogawa O, Matsui A, Iizuka T, Udagawa H, Kaise M. Feasibility and safety of laparoscopic and endoscopic cooperative surgery for gastric submucosal tumors, including esophagogastric junction tumors. Dig Endosc. 2014;26(4):538–44.

    Article  PubMed  Google Scholar 

  18. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Joensuu H. Risk stratification of patients diagnosed with gastrointestinal stromal tumor. Hum Pathol. 2008; 39(10): 1411–9.

    Article  PubMed  Google Scholar 

  20. Kim HS, Kim MG, Kim BS, Lee IS, Lee S, Yook JH, Kim BS. Laparoscopic surgery for submucosal tumor near the esophagogastric junction. J Laparoendosc Adv Surg Tech A. 2013;23(3):225–30.

    Article  PubMed  Google Scholar 

  21. Sakamoto H, Kitano M, Kudo M. Diagnosis of subepithelial tumors in the upper gastrointestinal tract by endoscopic ultrasonography. World J Radiol. 2010;2(8):289–97.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Nishida T, Goto O, Raut CP, Yahagi N. Diagnostic and treatment strategy for small gastrointestinal stromal tumors. Cancer. 2016;122(20):3110–3118.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Nishida T, Kawai N, Yamaguchi S, Nishida Y. Submucosal tumors: comprehensive guide for the diagnosis and therapy of gastrointestinal submucosal tumors. Dig Endosc. 2013;25(5):479–89.

    Article  PubMed  Google Scholar 

  24. Ntourakis D, Mavrogenis G. Cooperative laparoscopic endoscopic and hybrid laparoscopic surgery for upper gastrointestinal tumors: Current status. World J Gastroenterol. 2015;21(43):12482–97.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Jain D, Desai A, Mahmood E, Singhal S. Submucosal tunneling endoscopic resection of upper gastrointestinal tract tumors arising from muscularis propria. Ann Gastroenterol. 2017;30(3):262–272.

    PubMed  PubMed Central  Google Scholar 

  26. Zhou DJ, Dai ZB, Wells MM, Yu DL, Zhang J, Zhang L. Submucosal tunneling and endoscopic resection of submucosal tumors at the esophagogastric junction. World J Gastroenterol. 2015;21(2):578–83.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Lu J, Zheng M, Jiao T, Wang Y, Lu X. Transcardiac tunneling technique for endoscopic submucosal dissection of gastric fundus tumors arising from the muscularis propria. Endoscopy. 2014;46(10):888–92.

    Article  PubMed  Google Scholar 

  28. Li QL, Chen WF, Zhang C, Hu JW, Zhou PH, Zhang YQ, Zhong YS, Yao LQ, Xu MD. Clinical impact of submucosal tunneling endoscopic resection for the treatment of gastric submucosal tumors originating from the muscularis propria layer (with video). Surg Endosc. 2015;29(12):3640–6.

    Article  PubMed  Google Scholar 

  29. Wang XY, Xu MD, Yao LQ, Zhou PH, Pleskow D, Li QL, Zhang YQ, Chen WF, Zhong YS. Submucosal tunneling endoscopic resection for submucosal tumors of the esophagogastric junction originating from the muscularis propria layer: a feasibility study (with videos). Surg Endosc. 2014;28(6):1971–7.

    Article  PubMed  Google Scholar 

  30. Pelletier JS, Gill RS, Gazala S, Karmali S. A Systematic Review and Meta-Analysis of Open vs. Laparoscopic Resection of Gastric Gastrointestinal Stromal Tumors. J Clin Med Res. 2015;7(5):289–96.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Lukaszczyk JJ, Preletz RJ Jr. Laparoscopic resection of benign stromal tumor of the stomach. J Laparoendosc Surg. 1992;2(6):331–4.

    Article  CAS  PubMed  Google Scholar 

  32. Hu J, Or BH, Hu K, Wang ML. Comparison of the post-operative outcomes and survival of laparoscopic versus open resections for gastric gastrointestinal stromal tumors: A multi-center prospective cohort study. Int J Surg. 2016;33 Pt A:65–71.

    Article  PubMed  Google Scholar 

  33. Goh BK, Chow PK, Chok AY, Chan WH, Chung YF, Ong HS, Wong WK. Impact of the introduction of laparoscopic wedge resection as a surgical option for suspected small/medium-sized gastrointestinal stromal tumors of the stomach on perioperative and oncologic outcomes. World J Surg. 2010;34(8):1847–52.

    Article  PubMed  Google Scholar 

  34. Lin J, Huang C, Zheng C, Li P, **e J, Wang J, Lu J. Laparoscopic versus open gastric resection for larger than 5 cm primary gastric gastrointestinal stromal tumors (GIST): a size-matched comparison. Surg Endosc. 2014;28(9):2577–83.

    Article  PubMed  Google Scholar 

  35. Koh YX, Chok AY, Zheng HL, Tan CS, Chow PK, Wong WK, Goh BK. A systematic review and meta-analysis comparing laparoscopic versus open gastric resections for gastrointestinal stromal tumors of the stomach. Ann Surg Oncol. 2013;20(11):3549–60.

    Article  PubMed  Google Scholar 

  36. Chen K, Pan Y, Zhai ST, Pan JH, Yu WH, Chen DW, Yan JF, Wang XF. Short-term outcomes of laparoscopic local resection for gastric submucosal tumors: a single-center experience of 266 patients. BMC Surg. 2017;17(1):33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Ke ZW, Chen DL, Cai JL, Zheng CZ. Extraluminal laparoscopic wedge-resection of submucosal tumors on the posterior wall of the gastric fundus close to the esophagocardiac junction. J Laparoendosc Adv Surg Tech A. 2009;19(6):741–4.

    Article  PubMed  Google Scholar 

  38. 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(6):289–94.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No. 1 Shuai Fu Yuan, Dongcheng District, Bei**g, 100730, China

    **n Ye, Jianchun Yu, Weiming Kang, Zhiqiang Ma & Zhigang Xue

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  1. **n Ye
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Correspondence to Jianchun Yu.

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The protocol was approved by the Institutional Review Board at Peking Union Medical College Hospital.

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Ye, X., Yu, J., Kang, W. et al. Short- and Long-Term Outcomes of Endoscope-Assisted Laparoscopic Wedge Resection for Gastric Submucosal Tumors Adjacent to Esophagogastric Junction. J Gastrointest Surg 22, 402–413 (2018). https://doi.org/10.1007/s11605-017-3628-2

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