INTRODUCTION: Laparoscopic resection is considered the gold standard of treatment only for small gastric gastrointestinal stromal tumor (GIST). MATERIALS AND METHODS: Between January 2004 and September 2012, 38 consecutive gastric GISTs were operated on by laparoscopic approach, without conversions. Thirty-five cases were primary GISTs and three were bleeding GISTs with hepatic metastases non-responding to conservative therapy treated by emergency surgery. RESULTS: Median tumor size was 3.63 cm (1.8-17 cm). In two cases tumor size was <2 cm, between 2 and 5 cm in 26 cases, between 5 and 10 cm in eight cases, and >10 cm in two cases. In two cases, localization was in the cardia, fundus in ten cases, lesser curve in 11 cases, greater curve in 12 cases, and antrum in three cases. We performed 24 wedge resections, eight transgastric resections and six antrectomies. An Endo-GIA™ was used in 25 cases, and a manual laparoscopic reconstruction with extramucosal suture was performed in 13 cases. No postoperative mortality and morbidity was observed. The routine use of laparoscopy allowed us to perform resections in 100 % of cases, even in those where preoperative imaging suggested an open approach according to the current guidelines. CONCLUSIONS: The use of a pre-resection endobag avoids spillage and seeding, thus increasing the possibility of resection. In conclusion, we consider the laparoscopic approach as mandatory in all cases, always considering the possibility of converting to the open technique when necessary.
INTRODUCTION: Laparoscopic resection is considered the gold standard of treatment only for small gastric gastrointestinal stromal tumor (GIST). MATERIALS AND METHODS: Between January 2004 and September 2012, 38 consecutive gastric GISTs were operated on by laparoscopic approach, without conversions. Thirty-five cases were primary GISTs and three were bleeding GISTs with hepatic metastases non-responding to conservative therapy treated by emergency surgery. RESULTS: Median tumor size was 3.63 cm (1.8-17 cm). In two cases tumor size was <2 cm, between 2 and 5 cm in 26 cases, between 5 and 10 cm in eight cases, and >10 cm in two cases. In two cases, localization was in the cardia, fundus in ten cases, lesser curve in 11 cases, greater curve in 12 cases, and antrum in three cases. We performed 24 wedge resections, eight transgastric resections and six antrectomies. An Endo-GIA™ was used in 25 cases, and a manual laparoscopic reconstruction with extramucosal suture was performed in 13 cases. No postoperative mortality and morbidity was observed. The routine use of laparoscopy allowed us to perform resections in 100 % of cases, even in those where preoperative imaging suggested an open approach according to the current guidelines. CONCLUSIONS: The use of a pre-resection endobag avoids spillage and seeding, thus increasing the possibility of resection. In conclusion, we consider the laparoscopic approach as mandatory in all cases, always considering the possibility of converting to the open technique when necessary.
Authors: Martin D McCarter; Cristina R Antonescu; Karla V Ballman; Robert G Maki; Peter W T Pisters; George D Demetri; Charles D Blanke; Margaret von Mehren; Murray F Brennan; Linda McCall; David M Ota; Ronald P DeMatteo Journal: J Am Coll Surg Date: 2012-07 Impact factor: 6.113
Authors: Maria Debiec-Rychter; Bartosz Wasag; Michel Stul; Ivo De Wever; Allan Van Oosterom; Anne Hagemeijer; Raf Sciot Journal: J Pathol Date: 2004-04 Impact factor: 7.996
Authors: Ronald P Dematteo; Karla V Ballman; Cristina R Antonescu; Robert G Maki; Peter W T Pisters; George D Demetri; Martin E Blackstein; Charles D Blanke; Margaret von Mehren; Murray F Brennan; Shreyaskumar Patel; Martin D McCarter; Jonathan A Polikoff; Benjamin R Tan; Kouros Owzar Journal: Lancet Date: 2009-03-18 Impact factor: 79.321
Authors: Chang In Choi; Si Hak Lee; Sun Hwi Hwang; Dae Hwan Kim; Tae Yong Jeon; Dong Heon Kim; Do Youn Park Journal: Surg Endosc Date: 2015-07-03 Impact factor: 4.584
Authors: Sebastian H Lamm; Daniel C Steinemann; Georg R Linke; Dietmar Eucker; Thomas Simon; Andreas Zerz; Reinhard Stoll Journal: Surg Endosc Date: 2014-12-25 Impact factor: 4.584