Laparoscopic gastric resection for gastrointestinal stromal tumors.
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.
Sexton
Jennifer A
JA
Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8109, St. Louis, MO 63110, USA. jennifer.a.sexton@gmail.com
Pierce
Richard A
RA
Halpin
Valerie J
VJ
Eagon
J Christopher
JC
Hawkins
William G
WG
Linehan
David C
DC
Brunt
L Michael
LM
Frisella
Margaret M
MM
Matthews
Brent D
BD
D000293:Adolescent; D000368:Aged; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000379:methods; D004943:Esophagogastric Junction / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D046152:Gastrointestinal Stromal Tumors / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009366:Neoplasm Seeding; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D011708:Pylorus / Q000601:surgery; D012189:Retrospective Studies; D012306:Risk; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult