Laparoscopic resection of small gastric submucosal tumors.
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.
Ryu
Ki-Jin
KJ
Department of Surgery, Korea University College of Medicine, Seoul, Korea.
Jung
Sae-Rom
SR
Choi
Jung-Soon
JS
Jang
You-Jin
YJ
Kim
Jong-Han
JH
Park
Sung-Soo
SS
Park
Beom Jin
BJ
Park
Seong-Heum
SH
Kim
Seung-Joo
SJ
Mok
Young-Jae
YJ
Kim
Chong-Suk
CS
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