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Long-Term Outcomes of Combined Endoscopic/Laparoscopic Intragastric Enucleation of Gastric Stromal Tumors
Alfredo D. Guerron*, Kevin M. El-Hayek, Jeffrey Mino, Rosebel Monteiro, Matthew Walsh
General Surgery, Cleveland Clinic, Cleveland, OH
PURPOSE: Definitive surgical treatment of gastric myogenic tumors 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 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: There were 15 patients who underwent intraluminal enucleation followed for a median follow-up of 61 months. There were 8 men and 7 women with a mean age of 62.1 +/- 3.38 years. Patients underwent endoscopy for gastrointestinal bleeding in 8 (53%), dyspepsia in 6 (40%), anemia in 6 (40%), and abdominal pain in 4 (27%). Eight lesions (53%) were located in the fundus/cardia, 6 (40%) in the body, and 2 (13%) in the antrum. The mean tumor size was 3.5 +/- 0.45 (1.5-7.0) cm. All were GIST lesions with benign histologic features. All operations were successfully completed with no conversion to open procedure, major morbidity or mortality. Complete endoscopic and endosonographic surveillance was accomplished in 14 patients with no recurrence and no symptomatic follow-up in any patient.
CONCLUSION: Enucleation of gastrointestinal stromal tumors can be accomplished with low risk of recurrence when done with a combined endoscopic/laparoscopic intraluminal technique. It should be strongly considered for small, proximal intraluminal tumors.
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