title: Laparoscopic management of gastrointestinal stromal tumours: review at a Canadian centre.
abstract: BACKGROUND
  Laparoscopic wedge resection has been widely accepted for small benign gastric tumours. Large gastrointestinal stromal tumours (GISTs), however, can be difficult to manipulate laparoscopically and are at risk for capsule disruption, which can then result in peritoneal seeding. Some authors have suggested that large GISTs (> 8 cm) are best approached using an open technique. However, there has been no consensus as to what the cut-off size should be. We conducted one of the largest Canadian series to date to assess outcomes and follow-up of the laparoscopic management of GISTs.
  
  
  METHODS
  All patients with gastric GISTs presenting to Vancouver General Hospital and University of British Columbia Hospital between 2000 and 2008 were reviewed. Most lesions were resected using a wedge technique with closure of the stomach facilitated by an endoscopic linear stapling device.
  
  
  RESULTS
  In all, 23 patients presented with GISTs; 19 patients underwent laparoscopic resection and, of these, 15 had a purely laparoscopic operation and 4 had a hand-assisted laparoscopic resection. Mean tumour size was 3.2 cm, with the largest tumour measuring 6.8 cm. There were no episodes of tumour rupture or spillage and no major intraoperative complications. All margins were negative. Mean follow-up was 13.3 (range 1-78) months. There was no evidence of recurrence or metastasis.
  
  
  CONCLUSIONS
  The laparoscopic management of gastric GISTs is safe and effective with short hospital stays and good results over a mean follow-up of 13.3 months. We believe that it should be the preferred technique offered to patients.
authors.affiliation: Department of Surgery, University of British Columbia, Vancouver, BC.
authors.forename: Carl
authors.initials: C
authors.lastname: Daigle
authors.forename: Adam T
authors.initials: AT
authors.lastname: Meneghetti
authors.forename: Jasmine
authors.initials: J
authors.lastname: Lam
authors.forename: Ormond N M
authors.initials: ON
authors.lastname: Panton
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D001955:British Columbia; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods; D046152:Gastrointestinal Stromal Tumors / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D006785:Hospitals, University; D006801:Humans; D007150:Immunohistochemistry; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome