Tailored-approach of laparoscopic wedge resection for treatment of submucosal tumor near the esophagogastric junction.
BACKGROUND
Laparoscopic wedge resection (LWR) of the stomach cannot easily be applied to tumors that are located near the esophagogastric junction (EGJ). To define the tailored approach for this type of tumors, we evaluated our laparoscopic surgical technique and clinical outcomes.


METHODS
We successfully performed 10 LWRs for patients with submucosal tumor (SMT) located 3 cm or less from the esophagogastric junction. A presumptive diagnosis of gastrointestinal stromal tumor (GIST) was made in all the cases, based on endoscopic and radiologic examinations. The patient demographics, perioperative parameters and outcomes of 10 patients were assessed.


RESULTS
Neither intraoperative complications nor conversion to open surgery was required, and we were able to perform complete tumor excision with negative surgical margins for all the patients. The laparoscopic approaches of resection included the transgastric method (n = 5) and the exogastric method (n = 5). The mean operation time was 92.5 minutes (range 60-125 minutes). No blood transfusion was given for all cases in the perioperative period. The patients' oral intake was restored on the third postoperative day. The hospital stay ranged from three to seven days (mean: 4.9 days). Pathologic analysis of the resected specimens showed six GISTs, three leiomyomas, and one lipoma.


CONCLUSIONS
Laparoscopic resection of gastric SMTs located near the EGJ is a feasible and safe procedure. The laparoscopic approaches to this area should be tailored, based on the location, size and expanding pattern of the tumor.
Song
Kyo Young
KY
Department of Surgery, The Catholic University of Korea, College of Medicine, 505 Banpo-dong, Seocho-gu, Seoul, Korea.
Kim
Seung Nam
SN
Park
Cho Hyun
CH
D000328:Adult; D004435:Eating; D004943:Esophagogastric Junction; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007889:Leiomyoma / Q000601:surgery*; D007902:Length of Stay; D008067:Lipoma / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D013274:Stomach Neoplasms / Q000601:surgery*; D013997:Time Factors