Jeffrey S Mino1, Alfredo D Guerron2, Rosebel Monteiro2, Kevin El-Hayek2,3, Jeffrey L Ponsky2, Deepa T Patil4, R Matthew Walsh2. 1. Department of General Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. minoj@ccf.org. 2. Department of General Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. 3. Department of General Surgery, Cleveland Clinic Foundation, Abu Dhabi, United Arab Emirates. 4. Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
Abstract
PURPOSE: Definitive surgical treatment of gastric myogenic neoplasms such as gastrointestinal stromal tumors (GISTs) typically involves full-thickness resection of the lesion with normal gastric wall as the margin. This is not readily possible with proximal gastric lesions near the gastroesophageal junction, nor necessary for small incidental lesions. We have employed a combined endoscopic/laparoscopic intraluminal enucleation technique for selected patients and report long-term surveillance following this novel technique. METHODS: Retrospective review of patients who have undergone intraluminal laparoscopic resection from 1994 to 2008. RESULTS: Fifteen patients who underwent intraluminal enucleation were followed up for a median of 61 months. There were eight men and seven women with a mean age of 62.1 ± 3.38 years. Eight patients (53 %) underwent endoscopy for gastrointestinal bleeding, six for dyspepsia (40 %), six for anemia (40 %), and four for abdominal pain (27 %). Eight lesions (53 %) were located in the fundus/cardia: six (40 %) in the body and two (13 %) in the antrum. The mean tumor size was 3.5 ± 0.45 (1.5-7.0) cm. GIST lesions with benign histologic features predominated. All operations were successfully completed, including full-thickness resections with no conversion to open procedure, major morbidity, or mortality. Complete endoscopic and endosonographic surveillance was accomplished in 14 patients with no local or distant recurrence and no symptomatic follow-up in any patient. CONCLUSION: Enucleation of intact gastrointestinal stromal tumors can be accomplished with low risk of recurrence when done with a combined endoscopic/laparoscopic intraluminal technique. It should be the preferred approach considered for small, proximal, intraluminal tumors.
PURPOSE: Definitive surgical treatment of gastric myogenic neoplasms such as gastrointestinal stromal tumors (GISTs) typically involves full-thickness resection of the lesion with normal gastric wall as the margin. This is not readily possible with proximal gastric lesions near the gastroesophageal junction, nor necessary for small incidental lesions. We have employed a combined endoscopic/laparoscopic intraluminal enucleation technique for selected patients and report long-term surveillance following this novel technique. METHODS: Retrospective review of patients who have undergone intraluminal laparoscopic resection from 1994 to 2008. RESULTS: Fifteen patients who underwent intraluminal enucleation were followed up for a median of 61 months. There were eight men and seven women with a mean age of 62.1 ± 3.38 years. Eight patients (53 %) underwent endoscopy for gastrointestinal bleeding, six for dyspepsia (40 %), six for anemia (40 %), and four for abdominal pain (27 %). Eight lesions (53 %) were located in the fundus/cardia: six (40 %) in the body and two (13 %) in the antrum. The mean tumor size was 3.5 ± 0.45 (1.5-7.0) cm. GIST lesions with benign histologic features predominated. All operations were successfully completed, including full-thickness resections with no conversion to open procedure, major morbidity, or mortality. Complete endoscopic and endosonographic surveillance was accomplished in 14 patients with no local or distant recurrence and no symptomatic follow-up in any patient. CONCLUSION: Enucleation of intact gastrointestinal stromal tumors can be accomplished with low risk of recurrence when done with a combined endoscopic/laparoscopic intraluminal technique. It should be the preferred approach considered for small, proximal, intraluminal tumors.
Authors: Y Otani; M Ohgami; N Igarashi; M Kimata; T Kubota; K Kumai; M Kitajima; M Mukai Journal: Surg Laparosc Endosc Percutan Tech Date: 2000-02 Impact factor: 1.719
Authors: António M Gouveia; Amadeu P Pimenta; Ana F Capelinha; Dionísio de la Cruz; Paula Silva; José M Lopes Journal: World J Surg Date: 2008-11 Impact factor: 3.352
Authors: Jung Ho Shim; Han Hong Lee; Han Mo Yoo; Hae Myung Jeon; Cho Hyun Park; Jun Gi Kim; Kyo Young Song Journal: J Surg Oncol Date: 2011-04-04 Impact factor: 3.454
Authors: In Ho Jeong; Ji Hun Kim; Sang Rim Lee; Jin Hong Kim; Jae Chul Hwang; Sung Jae Shin; Kee Myung Lee; Hoon Hur; Sang Uk Han Journal: Surg Laparosc Endosc Percutan Tech Date: 2012-06 Impact factor: 1.719
Authors: R Matthew Walsh; Jeffrey Ponsky; Fred Brody; Brent D Matthews; B Todd Heniford Journal: J Gastrointest Surg Date: 2003 Mar-Apr Impact factor: 3.452
Authors: Andre Ignee; Christian Jenssen; Michael Hocke; Yi Dong; Wen-Ping Wang; Xin-Wu Cui; Matthias Woenckhaus; Sevastita Iordache; Adrian Saftoiu; Gudrun Schuessler; Christoph F Dietrich Journal: Endosc Ultrasound Date: 2017 Jan-Feb Impact factor: 5.628