title: Predictors of unsuccessful laparoscopic resection of gastric submucosal neoplasms.
abstract: BACKGROUND
  While laparoscopy has become integral to the performance of foregut surgery, its optimal use in resection of gastric submucosal neoplasms, including gastrointestinal stromal tumors (GISTs), remains uncertain. Concern exists for technical feasibility related to tumor size and location, as well as oncologic outcome.
  
  
  METHODS
  From 2002 to 2012, 106 patients underwent resection for gastric submucosal neoplasms, comprising 79 laparoscopic and 27 open resections. Median follow-up was 15 months.
  
  
  RESULTS
  Patients were 62 ± 14 years and 56 % male. Mean tumor size was 5.5 ± 4.3 cm, with 76 % being GISTs. A total of 8 (10 %) conversions occurred in the laparoscopic cohort. On multivariate analysis, conversion was predicted by size greater than 8 cm, while recurrence was predicted by mitotic index (p < 0.05). Laparoscopic resection resulted in better perioperative outcomes, with less morbidity, operative time, blood loss, and length of stay (p < 0.05). No significant difference was seen in survival, with 90 % and 81 % alive 3 years after laparoscopic and open resection, respectively (HR 0.4; 95 % CI 0.1-1.3; p = 0.13).
  
  
  CONCLUSIONS
  Laparoscopic resection is feasible and effective in the management of gastric submucosal neoplasms, including GISTs. Caution should be reserved for tumors greater than 8 cm. Oncologic outcome appears to be predicted by tumor biology as opposed to surgical approach.
authors.affiliation: Department of Surgery, The University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: Sabha
authors.initials: S
authors.lastname: Ganai
authors.forename: Vivek N
authors.initials: VN
authors.lastname: Prachand
authors.forename: Mitchell C
authors.initials: MC
authors.lastname: Posner
authors.forename: John C
authors.initials: JC
authors.lastname: Alverdy
authors.forename: Eugene
authors.initials: E
authors.lastname: Choi
authors.forename: Mustafa
authors.initials: M
authors.lastname: Hussain
authors.forename: Irving
authors.initials: I
authors.lastname: Waxman
authors.forename: Marco G
authors.initials: MG
authors.lastname: Patti
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Roggin
mesh_terms: D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005753:Gastric Mucosa; D046152:Gastrointestinal Stromal Tumors / Q000601:surgery; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D017211:Treatment Failure