Extraluminal laparoscopic wedge-resection of submucosal tumors on the posterior wall of the gastric fundus close to the esophagocardiac junction.
OBJECTIVE
Laparoscopic resection of submucosal tumors in the gastric fundus, especially in the posterior wall near the esophagocardiac junction (ECJ), is difficult and time consuming and is and likely to cause esophageal stenosis and splenic injury. In this article, we report an extraluminal laparoscopic wedge-resection (ELWR) that minimizes these problems.


METHODS
Thirty-seven patients with submucosal tumors in the posterior wall of the gastric fundus received ELWR. The operation consisted of four steps: 1) localization of the tumor, 2) dissection of the omentum, 3) mobilization of the gastric fundus/upper pole of the spleen and exposure of the ECJ, and 4) resection of the gastric fundus with a linear endoscopic gastrointestinal anastomosis stapler.


RESULTS
None of the cases needed conversion to open surgery. Mean postoperative hospital stay was 5.5 +/- 1.0 days. The distance between the tumor and the incision margin ranged from 0.7 to 2.5 cm toward the ECJ. Pathologic examination revealed 7 cases of leiomyomas, 29 cases of stromal tumors (4 were low-grade malignant tumors), and 1 case of neurofibroma. There was no recurrence, metastasis, esophageal stenosis, or any other severe adverse event during the follow-up period (52 +/- 3.1 months).


CONCLUSIONS
ELWR is a safe, effective treatment for submucosal tumors in the posterior wall of the gastric fundus.
Ke
Zhong-Wei
ZW
The Minimally Invasive Surgery Center, Changhai Hospital, Second Military Medical University, Shanghai, China. kezhongwei@medmail.com.cn
Chen
Dan-Lei
DL
Cai
Jing-Li
JL
Zheng
Cheng-Zhu
CZ
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004210:Dissection; D004943:Esophagogastric Junction; D005260:Female; D005748:Gastric Fundus; D046152:Gastrointestinal Stromal Tumors / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D007889:Leiomyoma / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009455:Neurofibroma / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*; D017792:Surgical Stapling; D016896:Treatment Outcome