title: Long-term outcomes of percutaneous endoscopic intragastric surgery in the treatment of gastrointestinal stromal tumors at the esophagogastric junction.
abstract: BACKGROUND
  The treatment options for gastrointestinal stromal tumors (GITSs) at the esophagogastric junction (EGJ) are controversial. There have been reports on enucleation for EGJ GISTs in order to avoid gastrectomy. But the number of patients is too small, or the follow-up period is too short to evaluate it. The purpose of this study was to review our experience of 59 patients with EGJ GISTs treated by enucleation by percutaneous endoscopic intragastric surgery (PEIGS) and assess the clinical outcomes.
  
  
  METHODS
  PEIGS is performed as described below. Access ports are placed through the abdominal wall and the anterior wall of the stomach. Through the access ports, an endoscope and surgical instruments are inserted into the gastric lumen and tumor enucleation and closure of the defect are carried out. In this study, 59 patients with EGJ GISTs treated by PEIGS between 2005 and 2013 were enrolled. Their hospital records were reviewed, and follow-up data for 8 years were collected to analyze the outcomes.
  
  
  RESULTS
  En-bloc enucleation was achieved without tumor rupture in all. Average operation time was 172.3 min. Postoperative complications occurred in 3 (one localized peritonitis, one bleeding, and one surgical site infection). Average tumor size was 35.6 mm. Pathological findings confirmed negative margin in all specimens. The maximum follow-up period was 101 months. Multiple liver metastases were detected in two patients (at 12 and 29 months). The survival rate was 100 %. The disease-free rate was 98.3 % at 12 months and 96.6 % at 29 months, respectively.
  
  
  CONCLUSIONS
  As far as the short- and long-term outcomes of our experience are reviewed, PEIGS seems as curative as other aggressive resection methods such as proximal gastrectomy. Tumor enucleation by PEIGS, offering a chance to preserve the stomach, can be a preferable option in carefully selected patients with EGJ GISTs, when performed by a skilled surgeon.
authors.affiliation: Department of Surgery, Medical Topia Soka, 1-11-18, Yatsuka, Soka-City, Saitama, 3400028, Japan. kanehiraxy@yahoo.co.jp.
authors.forename: Eiji
authors.initials: E
authors.lastname: Kanehira
authors.affiliation: Department of Surgery, Medical Topia Soka, 1-11-18, Yatsuka, Soka-City, Saitama, 3400028, Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Kamei
authors.affiliation: Department of Surgery, Yotsuya Medical Cube, Tokyo, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Umezawa
authors.affiliation: Department of Surgery, Ageo Central General Hospital, Saitama, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kurita
authors.affiliation: Department of Surgery, Medical Topia Soka, 1-11-18, Yatsuka, Soka-City, Saitama, 3400028, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Tanida
authors.affiliation: Department of Surgery, Medical Topia Soka, 1-11-18, Yatsuka, Soka-City, Saitama, 3400028, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Nakagi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004943:Esophagogastric Junction / Q000601:surgery*; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010538:Peritonitis / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D013274:Stomach Neoplasms / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology
keywords: Endoluminal surgery; Enucleation; Esophagogastric junction; Gastrointestinal stromal tumor; Intragastric surgery; Long-term outcomes