Jaime Sampson Dávila1, Dulce Momblán1, Àngels Ginès2, Cristina Sánchez-Montes2, Isis Araujo2, David Saavedra-Pérez1, Antonio M Lacy3, Gloria Fernández-Esparrach4. 1. Department of General and Digestive Surgery, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain. 2. Endoscopy Unit, Gastroenterology Department, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain. 3. Department of General and Digestive Surgery, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain. alacy@clinic.ub.es. 4. Endoscopy Unit, Gastroenterology Department, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain. mgfernan@clinic.ub.es.
Abstract
BACKGROUND: Laparoscopic resection is considered the treatment of choice for gastric subepithelial tumors. Occasionally, it is necessary to perform an intraoperative gastroscopy to localize the lesion. There are no data in the literature addressing the factors that can predict when a combined laparoscopic-endoscopic approach will be needed. METHODS: A retrospective cohort study using a prospectively collected database was conducted. From January 2005 to December 2013, all the patients undergoing a laparoscopic gastric resection for subepithelial tumors irresectable by endoscopy were reviewed. Potential predictive factors for the need of an intraoperative endoscopy were analyzed. RESULTS: Thirty-eight consecutive patients (22 men and 16 women) with a mean age of 67 (41-86) years underwent laparoscopic gastric resection for subepithelial tumors. Fourteen (36.8%) patients required intraoperative endoscopic assessment. The only significant factors related to the need of endoscopic assessment during surgery were tumor growth pattern (P = 0.002) and size (P = 0.001). CONCLUSIONS: An accurate description of tumor growth pattern and size by EUS is recommended in the preoperative assessment of gastric subepithelial tumors. Small tumors (≤18 mm) with an intraluminal growth may need a combined endoscopic-assisted laparoscopic management.
BACKGROUND: Laparoscopic resection is considered the treatment of choice for gastric subepithelial tumors. Occasionally, it is necessary to perform an intraoperative gastroscopy to localize the lesion. There are no data in the literature addressing the factors that can predict when a combined laparoscopic-endoscopic approach will be needed. METHODS: A retrospective cohort study using a prospectively collected database was conducted. From January 2005 to December 2013, all the patients undergoing a laparoscopic gastric resection for subepithelial tumors irresectable by endoscopy were reviewed. Potential predictive factors for the need of an intraoperative endoscopy were analyzed. RESULTS: Thirty-eight consecutive patients (22 men and 16 women) with a mean age of 67 (41-86) years underwent laparoscopic gastric resection for subepithelial tumors. Fourteen (36.8%) patients required intraoperative endoscopic assessment. The only significant factors related to the need of endoscopic assessment during surgery were tumor growth pattern (P = 0.002) and size (P = 0.001). CONCLUSIONS: An accurate description of tumor growth pattern and size by EUS is recommended in the preoperative assessment of gastric subepithelial tumors. Small tumors (≤18 mm) with an intraluminal growth may need a combined endoscopic-assisted laparoscopic management.
Authors: George D Demetri; Robert S Benjamin; Charles D Blanke; Jean-Yves Blay; Paolo Casali; Haesun Choi; Christopher L Corless; Maria Debiec-Rychter; Ronald P DeMatteo; David S Ettinger; George A Fisher; Christopher D M Fletcher; Alessandro Gronchi; Peter Hohenberger; Miranda Hughes; Heikki Joensuu; Ian Judson; Axel Le Cesne; Robert G Maki; Michael Morse; Alberto S Pappo; Peter W T Pisters; Chandrajit P Raut; Peter Reichardt; Douglas S Tyler; Annick D Van den Abbeele; Margaret von Mehren; Jeffrey D Wayne; John Zalcberg Journal: J Natl Compr Canc Netw Date: 2007-07 Impact factor: 11.908