title: Laparoscopic resection of large gastric GISTs: feasibility and long-term results.
abstract: BACKGROUND
  Laparoscopy is the procedure of choice for the resection of gastric Gastrointestinal stromal tumors (GISTs) smaller than 2 cm; there is still debate regarding the most appropriate operative approach for larger GISTs. The aims of this study were to evaluate the safety and long-term efficacy of laparoscopic resection of gastric GISTs larger than 2 cm.
  
  
  METHODS
  Between 2007 and 2011, we prospectively enrolled all patients affected by gastric GIST larger than 2 cm. Exclusion criteria for the laparoscopic approach were the presence of metastases and the absence of any involvement of the esophago-gastric junction, the pyloric canal, or any adjacent organ. Final diagnosis of GIST was confirmed by histological and immunohistochemical analysis. Follow-up assessment included abdominal CT scans every 6 months for the first 2 years and yearly thereafter.
  
  
  RESULTS
  Twenty-four consecutive patients were enrolled. Twenty-one patients (87.5%) were symptomatic. The most common symptoms were gastrointestinal bleeding and abdominal pain. The mean tumor size was 5.51 cm (range 2.5-12.0 cm). GISTs were located in the lesser curvature in five cases (20.8%), in the greater curvature in seven cases (29.1%), in the posterior wall in one case (4.1%), in the anterior wall in eight cases (33.3%), and in the fundus in 3 cases (12.5%). Laparoscopic resection was possible in all cases and took on average of 55 min (range 30-105 min). Median blood loss was 24 ml. No major intraoperative complications were observed. Mortality rate was 0%. Median postoperative stay was 3 days. No patients were lost to follow-up. No recurrences occurred after a median follow-up period of 75 months.
  
  
  CONCLUSIONS
  Although larger randomized controlled trials comparing different surgical strategies for large gastric GISTs are warranted, our study supports the evidence that laparoscopic resection of gastric GISTs is feasible, safe, and effective on long-term clinical outcome even for lesions up to 12 cm.
authors.affiliation: Department of Surgery, School of Medicine and Psychology, University "Sapienza", Sant'Andrea Hospital, Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Masoni
authors.forename: Ivan
authors.initials: I
authors.lastname: Gentili
authors.forename: Riccardo
authors.initials: R
authors.lastname: Maglio
authors.forename: Massimo
authors.initials: M
authors.lastname: Meucci
authors.forename: Giancarlo
authors.initials: G
authors.lastname: D'Ambra
authors.forename: Emilio
authors.initials: E
authors.lastname: Di Giulio
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Nardo
authors.forename: Vito Domenico
authors.initials: VD
authors.lastname: Corleto
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D046152:Gastrointestinal Stromal Tumors / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome