Abstract
Background
Laparoscopic wedge resection (LWR) of the stomach cannot easily be applied to tumors that are located near the esophagogastric junction (EGJ). To define the tailored approach for this type of tumors, we evaluated our laparoscopic surgical technique and clinical outcomes.
Methods
We successfully performed 10 LWRs for patients with submucosal tumor (SMT) located 3 cm or less from the esophagogastric junction. A presumptive diagnosis of gastrointestinal stromal tumor (GIST) was made in all the cases, based on endoscopic and radiologic examinations. The patient demographics, perioperative parameters and outcomes of 10 patients were assessed.
Results
Neither intraoperative complications nor conversion to open surgery was required, and we were able to perform complete tumor excision with negative surgical margins for all the patients. The laparoscopic approaches of resection included the transgastric method (n = 5) and the exogastric method (n = 5). The mean operation time was 92.5 minutes (range 60–125 minutes). No blood transfusion was given for all cases in the perioperative period. The patients’ oral intake was restored on the third postoperative day. The hospital stay ranged from three to seven days (mean: 4.9 days). Pathologic analysis of the resected specimens showed six GISTs, three leiomyomas, and one lipoma.
Conclusions
Laparoscopic resection of gastric SMTs located near the EGJ is a feasible and safe procedure. The laparoscopic approaches to this area should be tailored, based on the location, size and expanding pattern of the tumor.
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References
Basso N, Rosato P, De Leo A, Picconi T, Trentino P, Fantini A, Silecchia G (2000) Laparoscopic treatment of gastric stromal tumors. Surg Endosc 14:524–526
Cheng HL, Lee WJ, Lai IR, Yuan RH, Yu SC (1999) Laparoscopic wedge resection of benign gastric tumor. Hepatogastroenterology 46:2100–2104
Aogi K, Hirai T, Mukaida H, Toge T, Haruma K, Kajiyama G (1999) Laparoscopic resection of submucosal gastric tumors. Surg Today 29:102–106
Tagaya N, Mikami H, Kogure H, Kubota K, Hosoya Y, Nagai H (2002) Laparoscopic intragastric stapled resection of gastric submucosal tumors located near the esophagogastric junction. Surg Endosc 16:177–179
Morinaga N, Sano A, Katayama K, Suzuki K, Kamisaka K, Asao T, Kuwano H (2004) Laparoscopic transgastric tumor-everting resection of the gastric submucosal tumor located near the esophagogastric junction. Surg Laparosc Endosc Percutan Tech 14:344–348
Adachi Y, Suematsu T, Shiraishi N, Katsuta T; Morimoto A, Kitano S, Akazawa K (1999) Quality of life after laparoscopy-assisted Billroth I gastrectomy. Ann Surg 229:49–54
Bouillot JL, Bresler L, Fagniez PL, Samama G, Champault G, Parent Y (2003) Laparoscopic resection of benign submucosal gastric tumors. Gastroenterol Clin Biol 27: 272–276
Clancy TV, Moore PM, Ramshaw DG, Kays CR (1994) Laparoscopic excision of a benign gastric tumor. J Laparoendosc Surg 4: 277–280
Korean Laparoscopic Gastrointestinal Surgery Study Group (2005) Nationwide Survey of Laparoscopic Gastric Surgery in Korea, 2004. J Korean Gastric Cancer Assoc 5:295–303
Choi YB, Oh ST (2000) Laparoscopy in the management of gastric submucosal tumors. Surg Endosc 14: 741–745
Ohashi S (1995) Laparoscopic intraluminal (intragastric) surgery for early gastric cancer. Surg Endosc 9: 169–171
Tagaya N, Mikami H, Igarashi A, Ishikawa K, Kogure H, Ohyama O (1997) Laparoscopic local resection for benign nonepithelial gastric tumors. J Laparoendosc Adv Surg Tech 7: 53–58
Ibrahim IM, Silvestri F, Zingler B (1997) Laparoscopic resection of posterior gastric leiomyoma. Surg Endosc 11: 277–279
Buyske J, McDonald M, Fernandez C, Munson JL, Sanders LE, Tsao J, Birkett DH (1997) Minimally invasive management of low-grade and benign gastric tumors. Surg Endosc 11: 1084–1087
Matthews BD, Walsh RM, Kercher KW, Sing RF, Pratt BL, Answini GA, Heniford BT (2002) Laparoscopic vs open resection ofgastric stromal tumors. Surg Endosc 16: 803–807
Motson RW, Fisher PW, Dawson JW (1995) Laparoscopic resection of a benign intragastric stromal tumor. Br J Surg 82: 1670
DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF (2000) Two hundred gastrointestinal stromal tumors: recurrence patterns and prognosis factors for survival. Ann Surg 1:51–58
Blay JY, Bonvalot S, Casali P, Choi H, Debiec-Richter M, Dei Tos AP, Emile JF, Gronchi A, Hogendoorn PC, Joensuu H, Le Cesne A, McClure J, Maurel J, Nupponen N, Ray-Coquard I, Reichardt P, Sciot R, Stroobants S, van Glabbeke M, van Oosterom A, Demetri GD, GIST consensus meeting panelists. (2005) Consensus meeting for the management of gastrointestinal stromal tumors Report of the GIST Consensus Conference of 20–21 March 2004, under the auspices of ESMO. Ann Oncol 16: 566–578
Mochizuki1 Y, Kodera Y, Fujiwara M, Ito S, Yamamura Y, Sawaki A, Yamao K, Kato T (2006) Laparoscopic Wedge Resection for Gastrointestinal Stromal Tumors of the Stomach: Initial Experience. Surg Today 36:341–347
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This work was supported partly by the Catholic Cancer Center
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Song, K.Y., Kim, S.N. & Park, C.H. Tailored-approach of laparoscopic wedge resection for treatment of submucosal tumor near the esophagogastric junction. Surg Endosc 21, 2272–2276 (2007). https://doi.org/10.1007/s00464-007-9369-7
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DOI: https://doi.org/10.1007/s00464-007-9369-7