title: Laparoscopic-endoscopic cooperative surgery for gastric submucosal tumors.
abstract: OBJECTIVE
  To assess the feasibility, safety, and advantages of minimally invasive laparoscopic-endoscopic cooperative surgery (LECS) for gastric submucosal tumors (SMT).
  
  
  METHODS
  We retrospectively analyzed 101 consecutive patients, who had undergone partial, proximal, or distal gastrectomy using LECS for gastric SMT at Peking Union Medical College Hospital from June 2006 to April 2013. All patients were followed up by visit or telephone. Clinical data, surgical approach, pathological features such as the size, location, and pathological type of each tumor; and follow-up results were analyzed. The feasibility, safety and effectiveness of LECS for gastric SMT were evaluated, especially for patients with tumors located near the cardia or pylorus.
  
  
  RESULTS
  The 101 patients included 43 (42.6%) men and 58 (57.4%) women, with mean age of 51.2 ± 13.1 years (range, 14-76 years). The most common symptom was belching. Almost all (n = 97) patients underwent surgery with preservation of the cardia and pylorus, with the other four patients undergoing proximal or distal gastrectomy. The mean distance from the lesion to the cardia or pylorus was 3.4 ± 1.3 cm, and the minimum distance from the tumor edge to the cardia was 1.5 cm. Tumor pathology included gastrointestinal stromal tumor in 78 patients, leiomyoma in 13, carcinoid tumors in three, ectopic pancreas in three, lipoma in two, glomus tumor in one, and inflammatory pseudotumor in one. Tumor size ranged from 1 to 8.2 cm, with 65 (64.4%) lesions < 2 cm, 32 (31.7%) > 2 cm, and four > 5 cm. Sixty-six lesions (65.3%) were located in the fundus, 21 (20.8%) in the body, 10 (9.9%) in the antrum, three (3.0%) in the cardia, and one (1.0%) in the pylorus. During a median follow-up of 28 mo (range, 1-69 mo), none of these patients experienced recurrence or metastasis. The three patients who underwent proximal gastrectomy experienced symptoms of regurgitation and belching.
  
  
  CONCLUSIONS
  Laparoscopic-endoscopic cooperative surgery is feasible and safe for patients with gastric submucosal tumor. Endoscopic intraoperative localization and support can help preserve the cardia and pylorus during surgery.
authors.affiliation: Wei-Ming Kang, Jian-Chun Yu, Zhi-Qiang Ma, Zi-Ran Zhao, Qing-Bin Meng, Xin Ye, Department of General Surgery, Peking Union Medical College Hospital, CAMS and PUMC, Beijing 100730, China.
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Kang
authors.forename: Jian-Chun
authors.initials: JC
authors.lastname: Yu
authors.forename: Zhi-Qiang
authors.initials: ZQ
authors.lastname: Ma
authors.forename: Zi-Ran
authors.initials: ZR
authors.lastname: Zhao
authors.forename: Qing-Bin
authors.initials: QB
authors.lastname: Meng
authors.forename: Xin
authors.initials: X
authors.lastname: Ye
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005773:Gastroscopy / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D055815:Young Adult
keywords: Endoscopy; Gastric submucosal tumor; Laparoscopic-endoscopic cooperative surgery; Laparoscopy; Minimally invasive surgery
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