title: Laparoscopic resection of small gastric submucosal tumors.
abstract: BACKGROUND
  No consensus exists regarding the necessity of operative resection for patients with small, asymptomatic gastric submucosal tumors (SMTs). The purpose of this study is to evaluate clinical outcomes of resection by minimally invasive surgery.
  
  
  METHODS
  The medical records of 20 consecutive patients who had undergone laparoscopic or robotic wedge resection for small (<5 cm) gastric SMTs between March 2008 and February 2009 were reviewed. Operative indications included all SMTs unquestionably visible by endoscopy, irrespective of symptoms. The operative procedures, clinicopathologic features, and operative results were assessed.
  
  
  RESULTS
  Out of a total of 20 patients, 17 were asymptomatic, and 3 presented with vague abdominal discomfort. One patient had two tumors, therefore 21 total lesions were resected and evaluated (19 by laparoscopy and 2 by robotic procedures). There were 12 exogastric and 9 transgastric wedge resections. Mean operative time was 84 ± 28 min, and mean length of hospitalization was 4.7 ± 1.6 days. There were no major peri- or postoperative complications or mortalities. Mean tumor size was 2.4 ± 1.2 cm (range 0.6-4.8 cm). All lesions had microscopically negative resection margins. There were 16 gastrointestinal tumors (GISTs) and 5 other benign lesions. Fifteen of the GISTs had mitotic count (MC) <5 per 50 high-power fields (HPFs), and one lesion measuring 2.5 cm in size had MC of 38 per 50 HPFs.
  
  
  CONCLUSIONS
  Small size cannot guarantee a specific malignant risk for gastric SMTs. Laparoscopic/robotic wedge resection is safe and effective in treating small, asymptomatic lesions. Therefore, an active surgical approach should be considered for management of patients with small gastric SMTs.
authors.affiliation: Department of Surgery, Korea University College of Medicine, Seoul, Korea.
authors.forename: Ki-Jin
authors.initials: KJ
authors.lastname: Ryu
authors.forename: Sae-Rom
authors.initials: SR
authors.lastname: Jung
authors.forename: Jung-Soon
authors.initials: JS
authors.lastname: Choi
authors.forename: You-Jin
authors.initials: YJ
authors.lastname: Jang
authors.forename: Jong-Han
authors.initials: JH
authors.lastname: Kim
authors.forename: Sung-Soo
authors.initials: SS
authors.lastname: Park
authors.forename: Beom Jin
authors.initials: BJ
authors.lastname: Park
authors.forename: Seong-Heum
authors.initials: SH
authors.lastname: Park
authors.forename: Seung-Joo
authors.initials: SJ
authors.lastname: Kim
authors.forename: Young-Jae
authors.initials: YJ
authors.lastname: Mok
authors.forename: Chong-Suk
authors.initials: CS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D058070:Asymptomatic Diseases; D002828:Choristoma / Q000473:pathology / Q000601:surgery; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007889:Leiomyoma / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D008940:Mitotic Index; D009361:Neoplasm Invasiveness; D009378:Neoplasms, Multiple Primary / Q000473:pathology / Q000601:surgery; D010179:Pancreas; D012189:Retrospective Studies; D012306:Risk; D012371:Robotics; D013272:Stomach Diseases / Q000473:pathology / Q000601:surgery; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D047368:Tumor Burden