TY - JOUR
T1 - Minimally invasive options for gastrointestinal stromal tumors of the stomach
AU - Mazer, Laura
AU - Worth, Patrick
AU - Visser, Brendan
N1 - Publisher Copyright:
© 2020, Springer Science+Business Media, LLC, part of Springer Nature.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020
Y1 - 2020
N2 - Background: Gastrointestinal stromal tumors (GIST) are rare mesenchymal tumors, most commonly arising in the stomach. Surgical resection remains the mainstay of cure, and can often be accomplished laparoscopically. Tumor size and location guide selection of appropriate resection technique. Methods: A retrospective review of all patients undergoing surgery at a single academic center between 2000 and 2018. Comparisons and descriptive statistics performed using student’s t test and χ2 test. Results: 77 patients underwent resection for gastric GIST, 53 (68%) laparoscopic. Patients undergoing open operations had significantly larger tumors (4 cm vs 7 cm, p < 0.001). Operative time was not significantly different between the two groups (117 min vs 104 min, p = 0.26). Median length of stay was significantly shorter for laparoscopic resection, and postoperative complication rate was lower. A review of the operative notes revealed four types of resection: non-anatomic stapled wedge resection, resection of a full-thickness “disk” of stomach around the tumor with primary closure, formal partial gastrectomy with reconstruction, and laparoscopic transgastric (endoluminal) resection. Conclusion: Non-anatomic resection (wedge or disk) is most feasible for tumors on the greater curve or gastric body, far enough from the pylorus and gastroesophageal junction to avoid narrowing inflow or outflow. A partial gastrectomy may be required for large tumors or those encroaching on the esophagus or pylorus. For small intraluminal tumors, a laparoscopic transgastric approach is ideal. This review of the technical details of each type of resection can aid in selecting the ideal approach for difficult tumors.
AB - Background: Gastrointestinal stromal tumors (GIST) are rare mesenchymal tumors, most commonly arising in the stomach. Surgical resection remains the mainstay of cure, and can often be accomplished laparoscopically. Tumor size and location guide selection of appropriate resection technique. Methods: A retrospective review of all patients undergoing surgery at a single academic center between 2000 and 2018. Comparisons and descriptive statistics performed using student’s t test and χ2 test. Results: 77 patients underwent resection for gastric GIST, 53 (68%) laparoscopic. Patients undergoing open operations had significantly larger tumors (4 cm vs 7 cm, p < 0.001). Operative time was not significantly different between the two groups (117 min vs 104 min, p = 0.26). Median length of stay was significantly shorter for laparoscopic resection, and postoperative complication rate was lower. A review of the operative notes revealed four types of resection: non-anatomic stapled wedge resection, resection of a full-thickness “disk” of stomach around the tumor with primary closure, formal partial gastrectomy with reconstruction, and laparoscopic transgastric (endoluminal) resection. Conclusion: Non-anatomic resection (wedge or disk) is most feasible for tumors on the greater curve or gastric body, far enough from the pylorus and gastroesophageal junction to avoid narrowing inflow or outflow. A partial gastrectomy may be required for large tumors or those encroaching on the esophagus or pylorus. For small intraluminal tumors, a laparoscopic transgastric approach is ideal. This review of the technical details of each type of resection can aid in selecting the ideal approach for difficult tumors.
KW - Endoscopy
KW - Gastric tumor
KW - GIST
KW - Laparoscopy
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U2 - 10.1007/s00464-020-07510-x
DO - 10.1007/s00464-020-07510-x
M3 - Article
C2 - 32221752
AN - SCOPUS:85082413096
VL - 35
SP - 1324
EP - 1330
JO - Surgical Endoscopy and Other Interventional Techniques
JF - Surgical Endoscopy and Other Interventional Techniques
SN - 0930-2794
IS - 3
ER -