BACKGROUBD: Fifty-six patients with gastric submucosal tumors were treated laparoscopically in Keio University Hospital since 1993. Among them thirty-seven lesions (66%) were diagnosed as stromal tumor. Clinicopathological findings of these cases are reviewed.
Indication: Our indication of curative local resection for submucosal tumor is; 1)20 mm < T < 50 mm, 2)Rapid increase in size indicating malignant potential, 3)location of the tumor is not on the cardia or pylorus. For the precise preoperative evaluation, not only barium meal but also endoscopic ultrasonography were performed.
Procedure: The entire surgical procedure was performed laparoscopically. Four or five trocars were inserted in the upper abdomen. When the tumor was located on the lesser or greater curvature, the gastric wall near the lesion was fully devascularized and exposed using laparoscopic coagulating shears. Pulling the tumor toward the abdominal wall, wedge resection of the gastric wall was performed using multifire endoscopic staplers, maintaining a safe margin from the tumor. To avoid the tumor cell dissemination, no-touch technique keeping the capsule of the tumor intact was carefully performed.
RESULTS: Thirty-seven stromal tumors were immunohistochemically sub-classified into 4 groups; gastrointestinal stromal tumor (GIST, 25 cases, 44.6%), Schwannoma (6 cases), myogenic tumor (5 cases), and mixed type (1 case). The mean tumor size was 35 mm. No major complication during postoperative course was experienced and the patients could discharge in 7-10 days uneventfully. All patients have survived without local recurrence or distant metastasis over the 8-year follow-up period. Laparoscopic wedge resection of the stomach for gastric stromal tumors can be regarded as a safe, curative and minimally invasive procedure when the patients are carefully selected.
Reference: Otani Y, et al, Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 10 (1): 19-23, 2000