Long-term outcomes of combined endoscopic/laparoscopic intragastric enucleation of presumed gastric stromal tumors.
OBJECTIVE
Definitive surgical treatment of gastric myogenic neoplasms such as gastrointestinal stromal tumors (GISTs) typically involves full-thickness resection of the lesion with normal gastric wall as the margin. This is not readily possible with proximal gastric lesions near the gastroesophageal junction, nor necessary for small incidental lesions. We have employed a combined endoscopic/laparoscopic intraluminal enucleation technique for selected patients and report long-term surveillance following this novel technique.


METHODS
Retrospective review of patients who have undergone intraluminal laparoscopic resection from 1994 to 2008.


RESULTS
Fifteen patients who underwent intraluminal enucleation were followed up for a median of 61 months. There were eight men and seven women with a mean age of 62.1 ± 3.38 years. Eight patients (53 %) underwent endoscopy for gastrointestinal bleeding, six for dyspepsia (40 %), six for anemia (40 %), and four for abdominal pain (27 %). Eight lesions (53 %) were located in the fundus/cardia: six (40 %) in the body and two (13 %) in the antrum. The mean tumor size was 3.5 ± 0.45 (1.5-7.0) cm. GIST lesions with benign histologic features predominated. All operations were successfully completed, including full-thickness resections with no conversion to open procedure, major morbidity, or mortality. Complete endoscopic and endosonographic surveillance was accomplished in 14 patients with no local or distant recurrence and no symptomatic follow-up in any patient.


CONCLUSIONS
Enucleation of intact gastrointestinal stromal tumors can be accomplished with low risk of recurrence when done with a combined endoscopic/laparoscopic intraluminal technique. It should be the preferred approach considered for small, proximal, intraluminal tumors.
Department of General Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. minoj@ccf.org.
Jeffrey S
JS
Mino
Department of General Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
Alfredo D
AD
Guerron
Department of General Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
Rosebel
R
Monteiro
Department of General Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.|Department of General Surgery, Cleveland Clinic Foundation, Abu Dhabi, United Arab Emirates.
Kevin
K
El-Hayek
Department of General Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
Jeffrey L
JL
Ponsky
Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
Deepa T
DT
Patil
Department of General Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
R Matthew
RM
Walsh
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D046152:Gastrointestinal Stromal Tumors / Q000000981:diagnostic imaging / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
Endoscopic; Enucleation; GIST; Intraluminal; Laparoscopic