title: Laparoscopic resection of large gastric gastrointestinal stromal tumours.
abstract: BACKGROUND
  Gastrointestinal stromal tumours (GISTs) are a rare class of neoplasms that are seen most commonly in the stomach. Due to their malignant potential, surgical resection is the recommended method for management of these tumours. Many reports have described the ability to excise small and medium sized GISTs laparoscopically, but laparoscopic resection of GISTs greater than 5 cm is still a matter of debate.
  
  
  OBJECTIVE
  To investigate the feasibility and effectiveness of laparoscopic surgical techniques for management of large gastric GISTs greater than 4 cm and to detail characteristics of this type of tumour.
  
  
  METHODS
  The study cohort consisted of 11 patients with suspected gastric GISTs who were treated from 2011 to April 2014 in a single institution. All patients underwent laparoscopic resection of a gastric GIST.
  
  
  RESULTS
  Eleven patients underwent laparoscopic resection of a suspected gastric GIST between April 2011 and April 2014. The cohort consisted of 6 males and 5 females. Mean age was 67 years (range: 43-92 years). Sixty-four percent of these patients presented with symptomatic tumours. Four (36.4%) patients underwent laparoscopic transgastric resection (LTR), 3 (27.3%) laparoscopic sleeve gastrectomy (LSG), 3 (27.3%) laparoscopic wedge resection (LWR) and 1 (9%) laparoscopic distal gastrectomy (LDG). The mean operative time was 215 min. The mean tumour size was 6 cm (range: 4-9 cm). The mean tumour size for LTR was 5.5 cm (range: 4-6.3 cm), for LWR 5.3 cm (range: 4.5-7 cm), for LSG 6.5 cm (range: 4-9 cm) and for LDG 9 cm. We experienced only minor postoperative complications.
  
  
  CONCLUSIONS
  Laparoscopic procedures can be successfully performed during management of large gastric GISTs, bigger than 4 cm, and should be considered for all non-metastatic cases. The appropriate approach can be determined by assessing the anatomical location of each tumour.
authors.affiliation: Connolly Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Smolarek
authors.affiliation: Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Eoghan
authors.initials: E
authors.lastname: Pomeroy
authors.affiliation: Saint John of God Hospital, Dublin, Ireland.
authors.forename: Fiona
authors.initials: F
authors.lastname: Kinnarney
authors.affiliation: Connolly Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland; Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Mayilone
authors.initials: M
authors.lastname: Arumugasamy
keywords: gastrointestinal stromal tumour; sleeve gastrectomy; transgastric resection; wedge resection