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Laparoscopic and endoscopic cooperative surgery is a feasible treatment procedure for intraluminal gastric gastrointestinal stromal tumors compared to endoscopic intragastric surgery

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Abstract

Background

Laparoscopic wedge resection of the stomach is an ideal procedure if the gastric gastrointestinal stromal tumors (GISTs) are located in the extraluminal stomach. When the tumor is located in the intraluminal stomach, two minimally invasive surgical procedures involving laparoscopic and endoscopic cooperative surgery (LECS) or endoscopic intragastric surgery (EIGS) are frequently performed. To date, there have been no comparative studies of LECS and EIGS in patients with intraluminal gastric GISTs regarding short-term and long-term outcomes. The aim of this study was to compare the safety and feasibility of LECS and EIGS in patients with intraluminal gastric GISTs.

Methods

This was a single-center retrospective study of 46 consecutive patients with intraluminal gastric GISTs who underwent minimally invasive surgery. LECS (n = 21) was performed between 2013 and 2015 and EIGS (n = 26) was performed between 2001 and 2013.

Results

The overall incidence of perioperative complications was significantly higher in the EIGS group than in the LECS group (40 vs 4.8%; P = 0.006). In the EIGS group, three patients with intraoperative gastric mucosal injury were followed-up throughout surgical repair (12%). An esophageal tear was found in one patient during oral removal of tumor (4%). Postoperative gastric hemorrhage occurred in three patients (12%) and superficial surgical site infection was observed in three patients (12%). In the LECS group, anastomotic leakage requiring additional drainage was observed in one patient (4.8%). EIGS had less favorable results regarding median time to resumption of first oral intake (2 vs 1 days; P = 0.005). Two of 46 patients (4.3%), including one patient who underwent LECS and one patient who underwent EIGS developed recurrence. No cause-specific deaths were observed.

Conclusion

LECS is a feasible and safe procedure for intraluminal gastric GISTs with regard to both short-term surgical and long-term oncological outcomes. Registration number: UMIN000026631.

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Acknowledgement

We thank Prof. Toshio Shimokawa from the Department of Clinical Research Center, Wakayama Medical University for the professional help with statistical analyses.

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Authors’ contribution

Study concept and design: Ojima and Yamaue. Acquisition of data: Ojima, Nakamura, Nakamori, Takifuji, and Takei. Analysis and interpretation of data: Ojima, Nakamura, and Nakamori. Drafting of the manuscript: Ojima, Nakamura, and Katsuda. Critical revision of the manuscript for important intellectual content: Yamaue. Statistical analysis: Ojima, Hayata, and Yamaue. Administrative, technical and material support: Nakamura, Takifuji, Hayata, Katsuda, and Yamaue.

Correspondence to Hiroki Yamaue.

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Disclosures

Drs. Toshiyasu Ojima, Masaki Nakamura, Mikihito Nakamori, Katsunari Takifuji, Keiji Hayata, Masahiro Katsuda, Yoh Takei, and Hiroki Yamaue have no conflicts of interests or financial ties to disclose.

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Laparoscopic and endoscopic cooperative surgery procedures and endoscopic intragastric surgery for intraluminal gastric gastrointestinal stromal tumors. Supplementary material 1 (MPG 202456 kb)

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Laparoscopic and endoscopic cooperative surgery procedures and endoscopic intragastric surgery for intraluminal gastric gastrointestinal stromal tumors. Supplementary material 1 (MPG 202456 kb)

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Ojima, T., Nakamura, M., Nakamori, M. et al. Laparoscopic and endoscopic cooperative surgery is a feasible treatment procedure for intraluminal gastric gastrointestinal stromal tumors compared to endoscopic intragastric surgery. Surg Endosc 32, 351–357 (2018). https://doi.org/10.1007/s00464-017-5683-x

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Keywords

  • Gastrointestinal stromal tumors
  • Laparoscopic and endoscopic cooperative surgery
  • Endoscopic intragastric surgery
  • Minimally invasive surgery