title: Laparo-endoscopic transgastric resection of gastric submucosal tumors.
abstract: BACKGROUND
  Laparoscopic and endoluminal surgical techniques have evolved and allowed improvements in the methods for treating benign and malignant gastrointestinal diseases. To date, only case reports have been reported on the application of a laparo-endoscopic approach for resecting gastric submucosal tumors (SMT). In this study, we aimed to evaluate the efficacy, safety, and oncologic outcomes of a laparo-endoscopic transgastric approach to resect tumors that would traditionally require either a laparoscopic or open surgical approach. Herein, we present the largest single institution series utilizing this technique for the resection of gastric SMT in North America.
  
  
  METHODS
  We performed a retrospective review of a prospectively collected patient database. Patients who presented for evaluation of gastric SMT were offered this surgical procedure and informed consents were obtained for participation in the study.
  
  
  RESULTS
  Fourteen patients were included in this study between August/2010 and January/2013. Eight (8) patients (57.1 %) were female and the median age was 56 years (range 29-78). Of the 14 cases, 8 patients (57.1 %) underwent laparo-endoscopic resection of SMTs with transgastric extraction, 5 patients (35.7 %) had conversions to traditional laparoscopic surgery, and 1 patient (7.2 %) was abandoned intraoperatively. The median operative time for this cohort was 80 min (range 35-167). Ten patients (71.4 %) had GISTs, 3 (21.4 %) had leiomyomas, and 1 (7.1 %) had schwannoma. There were no intraoperative complications. Two patients had postoperative staple line bleeding that required repeat endoscopy. The median hospital stay was 1 day (range 1-6) and there were no postoperative mortalities. At 12-month follow-up visit, only one GIST patient (10 %) had tumor recurrence.
  
  
  CONCLUSIONS
  Our experience suggests that this surgical approach is safe and efficient in the resection of gastric SMT with transgastric extraction. This study found no intraoperative complications and optimal oncologic outcomes during the follow-up period. Minimally invasive surgical approaches are emerging as a valid and potentially better approach for resecting malignancies; however, continued investigation is underway to further validate this data.
authors.affiliation: Center for the Future of Surgery, University of California at San Diego, 9500 Gilman Drive La Jolla, San Diego, CA, 92093, USA, jbarajasgamboa@gmail.com.
authors.forename: Juan S
authors.initials: JS
authors.lastname: Barajas-Gamboa
authors.forename: Geylor
authors.initials: G
authors.lastname: Acosta
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Savides
authors.forename: Jason K
authors.initials: JK
authors.lastname: Sicklick
authors.forename: Syed M Abbas
authors.initials: SM
authors.lastname: Fehmi
authors.forename: Alisa M
authors.initials: AM
authors.lastname: Coker
authors.forename: Shannon
authors.initials: S
authors.lastname: Green
authors.forename: Ryan
authors.initials: R
authors.lastname: Broderick
authors.forename: Diego F
authors.initials: DF
authors.lastname: Nino
authors.forename: Cristina R
authors.initials: CR
authors.lastname: Harnsberger
authors.forename: Martin A
authors.initials: MA
authors.lastname: Berducci
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Sandler
authors.forename: Mark A
authors.initials: MA
authors.lastname: Talamini
authors.forename: Garth R
authors.initials: GR
authors.lastname: Jacobsen
authors.forename: Santiago
authors.initials: S
authors.lastname: Horgan
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D046152:Gastrointestinal Stromal Tumors / Q000601:surgery; D005773:Gastroscopy; D006801:Humans; D010535:Laparoscopy; D007889:Leiomyoma / Q000601:surgery; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009442:Neurilemmoma / Q000601:surgery; D061646:Operative Time; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*