BACKGROUBD: Gastrointestinal stromal tumors (GISTs) are neoplasms of mesenchymal origin which are most often found in the stomach. Minimally invasive excision of GISTs has been described in small series with favorable results.
METHODS: We report the results of 16 consecutive patients, ranging in age from 38 to 86 years (mean 61.9) with gastric stromal tumors who underwent minimally invasive excision from April, 1997 to November, 2000. Eleven patients were diagnosed by preoperative upper endoscopy. In three patients undergoing laparoscopic Roux-en-Y gastric bypass for morbid obesity and two patients undergoing laparoscopic Nissen fundoplication and Collis gastroplasty, gastric stromal tumors were detected incidentally. All patients underwent intraoperative endoscopy for localization of the lesion. Tumors were excised with negative margins by laparoscopic gastric sleeve resection, laparoscopic wedge resection, or laparoscopic intragastric excision via anterior gastrotomy.
RESULTS: Ten (63%) patients presented with gastroesophageal reflux. Five (31%) patients had preoperative gastrointestinal bleeding. Abdominal pain was experienced by 6 (38%) patients and 3 (19%) were asymptomatic. Tumor size ranged from microscopic to 5 cm. Mean operative time was 195.5 minutes. There were no conversions. The average time to resumption of oral intake was 1.4 days and mean length of hospital stay was 2.9 days. Two patients had respiratory complications. There were no mortalities.
CONCLUSIONS: Minimally invasive resection of GISTs of the stomach is safe and effective and is greatly facilitated by the use of intraoperative endoscopy and endoscopic staplers. Benefits include an early resumption of oral intake and short inpatient stay.
