This study aimed to review clinical outcomes for patients selected to undergo laparoscopic resection for gastrointestinal stromal tumor (GIST) of the stomach.
All 112 laparoscopic gastric resections performed from February 1995 to March 2007 were reviewed. Pre- and postoperative variables were analyzed, and data are given as mean ± standard deviation.
Laparoscopic gastric resection was attempted for 63 GIST in 61 patients (31 men and 30 women) with a mean age was 59.1 ± 19 years. The tumors were located at the fundus (n = 19), antrum (n = 18), body (n = 17), gastroesophageal junction/cardia (n = 7), and pylorus (n = 2). Common presentations were upper gastrointestinal bleed (n = 29) and incidental finding on esophagogastroduodenoscopy (n = 17). The laparoscopic procedures performed were partial gastrectomy (n = 52), antrectomy (n = 4), esophagogastrectomy (n = 3), and endoscopically assisted and/or transgastric resection (n = 3). There was one conversion to open procedure for control of bleeding from the spleen. The mean tumor size was 3.8 ± 1.8 cm. Negative surgical margins were achieved in all but one case. The mean operative time was 151.9 ± 67.3 min, and the mean estimated blood loss was 97.4 ± 200.7 ml. A regular diet was resumed at a mean of 2.9 ± 1.6 days, and the mean length of hospital stay was 3.9 ± 2.2 days. The perioperative complication rate was 16.4% including deep vein thrombosis postoperative bleed, anastomotic stricture, and incisional hernia. One mortality occurred, due to respiratory failure. The GISTs included 48 rated as low risk, six rated as intermediate risk, and nine rated as high malignant potential. At a mean follow-up period of 15 ± 21.8 months (range, 0–103 months), three of nine patients with high malignant potential GIST experienced, respectively, metastatic disease to the liver, liver and lung, and peritoneum. At this writing, all the other patients are disease free.
Laparoscopic gastric resection for GIST is a feasible option. Adequate oncologic resection was achieved with 98.4% of patients chosen for laparoscopic resection. Resection margin positivity and recurrence rates are low after laparoscopic approaches for appropriately selected patients with GIST, demonstrating favorable characteristics.
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Kindblom L, Meis-Kindblom J, Bumming P, Dimitrijevic S, Miret M, Dortok A, Nilsson B (2002) Incidence, prevalence, phenotype, and biologic spectrum of gastrointestinal stromal tumors (GIST): a population-based study [abstract]. Ann Oncol 13(Suppl 5):157
Miettinen M, Sarlomo-Rikala M, Lasota J (1998) Gastrointestinal stromal tumours. Ann Chir Gynaecol 87:278–281
Perez EA, Livingstone AS, Franceschi D, Rocha-Lima C, Lee DJ, Hodgson N, Jorda M, Koniaris LG (2006) Current incidence and outcomes of gastrointestinal mesenchymal tumors including gastrointestinal stromal tumors. J Am Coll Surg 202:623–629
Miettinen M, Sarlomo-Rikala M, Lasota J (1999) Gastrointestinal stromal tumors: recent advances in understanding of their biology. Hum Pathol 30:1213–1220
Vanderwinden JM (1999) Role of interstitial cells of cajal and their relationship with the enteric nervous system. Eur J Morphol 37:250–256
Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O’Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW (2002) Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol 33:459–465
Piso P, Schlitt HJ, Klempnauer J (2000) Stromal sarcoma of the stomach: therapeutic considerations. Eur J Surg 166:954–958
Iwahashi M, Takifuji K, Ojima T, Nakamura M, Nakamori M, Nakatani Y, Ueda K, Ishida K, Naka T, Ono K, Yamaue H (2006) Surgical management of small gastrointestinal stromal tumors of the stomach. World J Surg 30:28–35
Novitsky YW, Kercher KW, Sing RF, Heniford BT (2006) Long-term outcomes of laparoscopic resection of gastric gastrointestinal stromal tumors. Ann Surg 243:738–745
Walsh RM, Ponsky J, Brody F, Matthews BD, Heniford BT (2003) Combined endoscopic/laparoscopic intragastric resection of gastric stromal tumors. J Gastrointest Surg 7:386–392
Matthews BD, Joels CS, Kercher KW, Heniford BT (2004) Gastrointestinal stromal tumors of the stomach. Minerva Chir 59:219–231
Matthews BD, Greene FL (2002) Endoluminal resection of gastric gastrointestinal stromal tumors. Min Inv Ther A Tech 11:279–284
Blay JY, Bonvalot S, Casali P, Choi H, Biec-Richter M, Dei Tos AP, Emile JF, Gronchi A, Hogendoorn PC, Joensuu H, Le CA, McClure J, Maurel J, Nupponen N, Ray-Coquard I, Reichardt P, Sciot R, Stroobants S, Van GM, van OA, Demetri GD (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
Demetri G, Benjamin R, Blanke CD et al (2004) NCCN task force report: optimal management of patients with gastrointestinal stromal tumor (GIST): expansion and update of NCCN clinical practice guidelines. J Natl Compr Cancer Netw 2(Suppl 1):S1–S26
The Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059
Raut CP, Morgan JA, Ashley SW (2007) Current issues in gastrointestinal stromal tumors: incidence, molecular biology, and contemporary treatment of localized and advanced disease. Curr Opin Gastroenterol 23:149–158
Lai IR, Lee WJ, Yu SC (2006) Minimally invasive surgery for gastric stromal cell tumors: intermediate follow-up results. J Gastrointest Surg 10:563–566
Tashiro T, Hasegawa T, Omatsu M, Sekine S, Shimoda T, Katai H (2005) Gastrointestinal stromal tumour of the stomach showing lymph node metastases. Histopathology 47:438–439
Choi SM, Kim MC, Jung GJ, et al. (2007) Laparoscopic wedge resection for gastric GIST: long-term follow-up results. Eur J Surg Oncol 33(4):444–447
Miettinen M, Lasota J (2006) Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol 23:70–83
Nilsson B, Bumming P, Meis-Kindblom JM, Oden A, Dortok A, Gustavsson B, Sablinska K, Kindblom LG (2005) Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era: a population-based study in western Sweden. Cancer 103:821–829
Besana-Ciani I, Boni L, Dionigi G, Benevento A, Dionigi R (2003) Outcome and long-term results of surgical resection for gastrointestinal stromal tumors (GIST). Scand J Surg 92:195–199
Samiian L, Weaver M, Velanovich V (2004) Evaluation of gastrointestinal stromal tumors for recurrence rates and patterns of long-term follow-up. Am Surg 70:187–191
Otani Y, Furukawa T, Yoshida M, Saikawa Y, Wada N, Ueda M, Kubota T, Mukai M, Kameyama K, Sugino Y, Kumai K, Kitajima M (2006) Operative indications for relatively small (2–5 cm) gastrointestinal stromal tumor of the stomach based on analysis of 60 operated cases. Surgery 139:484–492
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Sexton, J.A., Pierce, R.A., Halpin, V.J. et al. Laparoscopic gastric resection for gastrointestinal stromal tumors. Surg Endosc 22, 2583–2587 (2008). https://doi.org/10.1007/s00464-008-9807-1
- Gastric resection