Skip to main content

Advertisement

SpringerLink
Log in

Laparoscopic gastric resection for gastrointestinal stromal tumors

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

This study aimed to review clinical outcomes for patients selected to undergo laparoscopic resection for gastrointestinal stromal tumor (GIST) of the stomach.

Methods

All 112 laparoscopic gastric resections performed from February 1995 to March 2007 were reviewed. Pre- and postoperative variables were analyzed, and data are given as mean ± standard deviation.

Results

Laparoscopic gastric resection was attempted for 63 GIST in 61 patients (31 men and 30 women) with a mean age was 59.1 ± 19 years. The tumors were located at the fundus (n = 19), antrum (n = 18), body (n = 17), gastroesophageal junction/cardia (n = 7), and pylorus (n = 2). Common presentations were upper gastrointestinal bleed (n = 29) and incidental finding on esophagogastroduodenoscopy (n = 17). The laparoscopic procedures performed were partial gastrectomy (n = 52), antrectomy (n = 4), esophagogastrectomy (n = 3), and endoscopically assisted and/or transgastric resection (n = 3). There was one conversion to open procedure for control of bleeding from the spleen. The mean tumor size was 3.8 ± 1.8 cm. Negative surgical margins were achieved in all but one case. The mean operative time was 151.9 ± 67.3 min, and the mean estimated blood loss was 97.4 ± 200.7 ml. A regular diet was resumed at a mean of 2.9 ± 1.6 days, and the mean length of hospital stay was 3.9 ± 2.2 days. The perioperative complication rate was 16.4% including deep vein thrombosis postoperative bleed, anastomotic stricture, and incisional hernia. One mortality occurred, due to respiratory failure. The GISTs included 48 rated as low risk, six rated as intermediate risk, and nine rated as high malignant potential. At a mean follow-up period of 15 ± 21.8 months (range, 0–103 months), three of nine patients with high malignant potential GIST experienced, respectively, metastatic disease to the liver, liver and lung, and peritoneum. At this writing, all the other patients are disease free.

Conclusions

Laparoscopic gastric resection for GIST is a feasible option. Adequate oncologic resection was achieved with 98.4% of patients chosen for laparoscopic resection. Resection margin positivity and recurrence rates are low after laparoscopic approaches for appropriately selected patients with GIST, demonstrating favorable characteristics.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kindblom L, Meis-Kindblom J, Bumming P, Dimitrijevic S, Miret M, Dortok A, Nilsson B (2002) Incidence, prevalence, phenotype, and biologic spectrum of gastrointestinal stromal tumors (GIST): a population-based study [abstract]. Ann Oncol 13(Suppl 5):157

    Google Scholar 

  2. Miettinen M, Sarlomo-Rikala M, Lasota J (1998) Gastrointestinal stromal tumours. Ann Chir Gynaecol 87:278–281

    PubMed  CAS  Google Scholar 

  3. Perez EA, Livingstone AS, Franceschi D, Rocha-Lima C, Lee DJ, Hodgson N, Jorda M, Koniaris LG (2006) Current incidence and outcomes of gastrointestinal mesenchymal tumors including gastrointestinal stromal tumors. J Am Coll Surg 202:623–629

    Article  PubMed  Google Scholar 

  4. Miettinen M, Sarlomo-Rikala M, Lasota J (1999) Gastrointestinal stromal tumors: recent advances in understanding of their biology. Hum Pathol 30:1213–1220

    Article  PubMed  CAS  Google Scholar 

  5. Vanderwinden JM (1999) Role of interstitial cells of cajal and their relationship with the enteric nervous system. Eur J Morphol 37:250–256

    Article  PubMed  CAS  Google Scholar 

  6. Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O’Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW (2002) Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol 33:459–465

    Article  PubMed  Google Scholar 

  7. Piso P, Schlitt HJ, Klempnauer J (2000) Stromal sarcoma of the stomach: therapeutic considerations. Eur J Surg 166:954–958

    Article  PubMed  CAS  Google Scholar 

  8. Iwahashi M, Takifuji K, Ojima T, Nakamura M, Nakamori M, Nakatani Y, Ueda K, Ishida K, Naka T, Ono K, Yamaue H (2006) Surgical management of small gastrointestinal stromal tumors of the stomach. World J Surg 30:28–35

    Article  PubMed  Google Scholar 

  9. Novitsky YW, Kercher KW, Sing RF, Heniford BT (2006) Long-term outcomes of laparoscopic resection of gastric gastrointestinal stromal tumors. Ann Surg 243:738–745

    Article  PubMed  Google Scholar 

  10. Walsh RM, Ponsky J, Brody F, Matthews BD, Heniford BT (2003) Combined endoscopic/laparoscopic intragastric resection of gastric stromal tumors. J Gastrointest Surg 7:386–392

    Article  PubMed  Google Scholar 

  11. Matthews BD, Joels CS, Kercher KW, Heniford BT (2004) Gastrointestinal stromal tumors of the stomach. Minerva Chir 59:219–231

    PubMed  CAS  Google Scholar 

  12. Matthews BD, Greene FL (2002) Endoluminal resection of gastric gastrointestinal stromal tumors. Min Inv Ther A Tech 11:279–284

    Google Scholar 

  13. Blay JY, Bonvalot S, Casali P, Choi H, Biec-Richter M, Dei Tos AP, Emile JF, Gronchi A, Hogendoorn PC, Joensuu H, Le CA, McClure J, Maurel J, Nupponen N, Ray-Coquard I, Reichardt P, Sciot R, Stroobants S, Van GM, van OA, Demetri GD (2005) Consensus meeting for the management of gastrointestinal stromal tumors. Report of the GIST Consensus Conference of 20–21 March 2004, under the auspices of ESMO. Ann Oncol 16:566–578

    Article  PubMed  Google Scholar 

  14. Demetri G, Benjamin R, Blanke CD et al (2004) NCCN task force report: optimal management of patients with gastrointestinal stromal tumor (GIST): expansion and update of NCCN clinical practice guidelines. J Natl Compr Cancer Netw 2(Suppl 1):S1–S26

    Google Scholar 

  15. The Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059

    Article  Google Scholar 

  16. Raut CP, Morgan JA, Ashley SW (2007) Current issues in gastrointestinal stromal tumors: incidence, molecular biology, and contemporary treatment of localized and advanced disease. Curr Opin Gastroenterol 23:149–158

    Article  PubMed  Google Scholar 

  17. Lai IR, Lee WJ, Yu SC (2006) Minimally invasive surgery for gastric stromal cell tumors: intermediate follow-up results. J Gastrointest Surg 10:563–566

    Article  PubMed  Google Scholar 

  18. Tashiro T, Hasegawa T, Omatsu M, Sekine S, Shimoda T, Katai H (2005) Gastrointestinal stromal tumour of the stomach showing lymph node metastases. Histopathology 47:438–439

    Article  PubMed  CAS  Google Scholar 

  19. Choi SM, Kim MC, Jung GJ, et al. (2007) Laparoscopic wedge resection for gastric GIST: long-term follow-up results. Eur J Surg Oncol 33(4):444–447

    Article  PubMed  Google Scholar 

  20. Miettinen M, Lasota J (2006) Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol 23:70–83

    Article  PubMed  Google Scholar 

  21. Nilsson B, Bumming P, Meis-Kindblom JM, Oden A, Dortok A, Gustavsson B, Sablinska K, Kindblom LG (2005) Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era: a population-based study in western Sweden. Cancer 103:821–829

    Article  PubMed  Google Scholar 

  22. Besana-Ciani I, Boni L, Dionigi G, Benevento A, Dionigi R (2003) Outcome and long-term results of surgical resection for gastrointestinal stromal tumors (GIST). Scand J Surg 92:195–199

    PubMed  CAS  Google Scholar 

  23. Samiian L, Weaver M, Velanovich V (2004) Evaluation of gastrointestinal stromal tumors for recurrence rates and patterns of long-term follow-up. Am Surg 70:187–191

    PubMed  Google Scholar 

  24. Otani Y, Furukawa T, Yoshida M, Saikawa Y, Wada N, Ueda M, Kubota T, Mukai M, Kameyama K, Sugino Y, Kumai K, Kitajima M (2006) Operative indications for relatively small (2–5 cm) gastrointestinal stromal tumor of the stomach based on analysis of 60 operated cases. Surgery 139:484–492

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8109, St. Louis, MO, 63110, USA

    Jennifer A. Sexton, Richard A. Pierce, Valerie J. Halpin, J. Christopher Eagon, William G. Hawkins, David C. Linehan, L. Michael Brunt, Margaret M. Frisella & Brent D. Matthews

Authors
  1. Jennifer A. Sexton
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Richard A. Pierce
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Valerie J. Halpin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Christopher Eagon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. William G. Hawkins
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. David C. Linehan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. L. Michael Brunt
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Margaret M. Frisella
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Brent D. Matthews
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brent D. Matthews.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sexton, J.A., Pierce, R.A., Halpin, V.J. et al. Laparoscopic gastric resection for gastrointestinal stromal tumors. Surg Endosc 22, 2583–2587 (2008). https://doi.org/10.1007/s00464-008-9807-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-008-9807-1

Keywords

Search

Navigation