Simultaneous use of laparoscopy and endoscopy for minimally invasive resection of gastric subepithelial masses - analysis of 93 interventions.
BACKGROUND
Subepithelial gastric tumors are common findings during upper gastrointestinal endoscopy. Tumor resection is mostly done laparoscopically, but there is still discussion concerning the size of lesion for which the treatment may be minimally invasive; additionally there is very little data available concerning patient outcome after minor access surgery.


METHODS
Clinicopathologic features and survival data of 93 consecutive patients undergoing a combined laparoscopic-endoscopic approach for gastric submucosal tumors were prospectively analyzed. Analysis included preoperative diagnostic work-up, perioperative data, and postoperative complications. Follow-up was carried out for patients with GIST to check for tumor recurrence.


RESULTS
It was possible to resect 88 of 93 lesions by the laparoscopic-endoscopic approach, with tumor-free margins in all patients. Intraoperative endoscopy facilitated exact tumor localization in 92 patients. Most lesions were removed by endoscopic-laparoscopic wedge resection or, less frequently, by a combined transgastric approach. Mean operative time was 90.7 min; the postoperative hospitalization was 7.3 days. Adverse events appeared in 7.5%, and conversion to open surgery was required in 6.5%. For patients suffering from gastrointestinal stromal tumors, there was no tumor recurrence at a mean follow-up of 40 months.


CONCLUSIONS
Combined laparoscopic-endoscopic "rendez-vous" procedures are easy to perform and offer a curative approach for almost all gastric submucosal lesions. The technique is associated with low morbidity and short hospitalization. Though even patients with large GISTs of intermediate and high risk were treated, no tumor recurrence has been observed to date.
Wilhelm
D
D
Department of Surgery, Klinikum r. d. Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany.
von Delius
S
S
Burian
M
M
Schneider
A
A
Frimberger
E
E
Meining
A
A
Feussner
H
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000473:pathology; D005773:Gastroscopy; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*