title: Gastrointestinal stromal tumors of the stomach: the role of laparoscopic resection. Single-centre experience of 38 cases.
abstract: BACKGROUND
  Laparoscopic resection is considered the gold standard of treatment only for small gastric gastrointestinal stromal tumor (GIST).
  
  
  METHODS
  Between January 2004 and September 2012, 38 consecutive gastric GISTs were operated on by laparoscopic approach, without conversions. Thirty-five cases were primary GISTs and three were bleeding GISTs with hepatic metastases non-responding to conservative therapy treated by emergency surgery.
  
  
  RESULTS
  Median tumor size was 3.63 cm (1.8-17 cm). In two cases tumor size was <2 cm, between 2 and 5 cm in 26 cases, between 5 and 10 cm in eight cases, and >10 cm in two cases. In two cases, localization was in the cardia, fundus in ten cases, lesser curve in 11 cases, greater curve in 12 cases, and antrum in three cases. We performed 24 wedge resections, eight transgastric resections and six antrectomies. An Endo-GIA™ was used in 25 cases, and a manual laparoscopic reconstruction with extramucosal suture was performed in 13 cases. No postoperative mortality and morbidity was observed. The routine use of laparoscopy allowed us to perform resections in 100 % of cases, even in those where preoperative imaging suggested an open approach according to the current guidelines.
  
  
  CONCLUSIONS
  The use of a pre-resection endobag avoids spillage and seeding, thus increasing the possibility of resection. In conclusion, we consider the laparoscopic approach as mandatory in all cases, always considering the possibility of converting to the open technique when necessary.
authors.affiliation: Department of Digestive Surgery, Regina Elena National Cancer Institute, Via E. Chianesi, 53, 00144, Rome, Italy, valle@ifo.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Valle
authors.forename: Orietta
authors.initials: O
authors.lastname: Federici
authors.forename: Fabio
authors.initials: F
authors.lastname: Carboni
authors.forename: Silvia
authors.initials: S
authors.lastname: Carpano
authors.forename: Michele
authors.initials: M
authors.lastname: Benedetti
authors.forename: Alfredo
authors.initials: A
authors.lastname: Garofalo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D003937:Diagnosis, Differential; D016099:Endoscopy, Gastrointestinal; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D046152:Gastrointestinal Stromal Tumors / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome