title: Tailored laparoscopic resection for suspected gastric gastrointestinal stromal tumors.
abstract: BACKGROUND
  The aim of the present study was to evaluate the long-term outcomes of tailored laparoscopic resections for suspected gastric gastrointestinal stromal tumors (GISTs) based on the tumor size, location, and growth morphology.
  
  
  METHODS
  Between February 1994 and April 2009, 64 patients undergoing gastric resections of suspected gastric GISTs were identified in a prospectively collected database. Medical records were reviewed for patient demographics, perioperative outcomes, and follow-up.
  
  
  RESULTS
  Forty-five patients underwent attempted laparoscopic resections, with 44 completed laparoscopically. Twenty-eight neoplasms were located in the upper third of the stomach (including 6 neoplasms at the esophagogastric junction), 9 in the middle third, and 8 in the lower third (including 4 prepyloric neoplasms). Laparoscopic approaches included 35 exogastric (3 single incision access) and 10 transgastric approaches. Median operating time was 100min (range, 30-240), and blood loss was 5ml (range, 1-80). Median tumor size and operative margin were 32mm (range, 16-74) and 7mm (range, 1-20), respectively. One patient was converted to an open, pylorus-preserving gastrectomy. One patient developed a complication. The histopathologic risk assessment classifications of 37 GISTs were 2 very low, 26 low, 7 intermediate, and 2 high risk. Although 1 patient developed a local recurrence after intragastric resection, all 45 patients were disease free at a median follow-up of 74 months (range, 1-181).
  
  
  CONCLUSIONS
  Although technically demanding, tailored laparoscopic resection based on tumor characteristics in most patients with suspected gastric GIST is safe and feasible and resultis in good both surgical and oncologic outcomes.
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, Morioka, Japan. sakira@iwate-med.ac.jp
authors.forename: Akira
authors.initials: A
authors.lastname: Sasaki
authors.forename: Keisuke
authors.initials: K
authors.lastname: Koeda
authors.forename: Toru
authors.initials: T
authors.lastname: Obuchi
authors.forename: Jun
authors.initials: J
authors.lastname: Nakajima
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nishizuka
authors.forename: Masanori
authors.initials: M
authors.lastname: Terashima
authors.forename: Go
authors.initials: G
authors.lastname: Wakabayashi
mesh_terms: D044963:Biopsy, Fine-Needle; D002455:Cell Division; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods; D046152:Gastrointestinal Stromal Tumors / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008940:Mitotic Index; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D018570:Risk Assessment; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013537:Sutures; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography