title: Laparoscopic and luminal endoscopic cooperative surgery can be a standard treatment for submucosal tumors of the stomach: a retrospective multicenter study.
abstract: Background and study aimsWe have developed a combined laparoscopic and luminal endoscopic surgery technique for resection of gastric submucosal tumors (SMTs) that can be performed without excessive resection of the stomach. In a multicenter retrospective study we aimed to evaluate the feasibility and safety of laparoscopic and endoscopic cooperative surgery (LECS) for gastric SMT resection.Patients and methodsBetween October 2007 and December 2011, 126 patients with gastric SMTs underwent LECS at 8 institutions. Patient demographics, tumor histopathologic characteristics, and operative and follow-up data were reviewed.Results16 tumors (12.7 %) were located in the upper third of the stomach, 88 (69.8 %) in the middle third, 5 (4.0 %) in the lower third, and 17 (13.5 %) at the esophagogastric junction. The mean (standard deviation [SD]) operation time for LECS was 190.2 (66.8) min, with a mean estimated blood loss of 15.1 (38.6) mL. In 2 cases (1.6 %), the procedure was converted to open surgery because of intra-abdominal adhesions or stenosis. Morbidity was found in 6 cases (4.8 %), including 2 leakage, 2 gastric stasis, 1 fever, and 1 cystitis. Histologically, a gastrointestinal stromal tumor (GIST) was found in 86 (68.3 %) cases. The median follow-up period was 54.7 months; no local or distant tumor recurrence was observed and all patients were alive.ConclusionsLECS proved to be a safe and feasible procedure for the resection of gastric SMTs, with a reasonable operation time, low bleeding, and an acceptable complication rate in this multicenter study in Japan.
authors.affiliation: Department of Gastroenterological Surgery, Cancer Institute Ariake Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Matsuda
authors.affiliation: Department of Gastroenterological Surgery, Cancer Institute Ariake Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Souya
authors.initials: S
authors.lastname: Nunobe
authors.affiliation: Department of Gastroenterological Surgery, Cancer Institute Ariake Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kosuga
authors.affiliation: Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawahira
authors.affiliation: Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Inaki
authors.affiliation: Department of Surgery, Tonan Hospital, Sapporo, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Kitashiro
authors.affiliation: Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Nobutsugu
authors.initials: N
authors.lastname: Abe
authors.affiliation: Center for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Isao
authors.initials: I
authors.lastname: Miyashiro
authors.affiliation: Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan.
authors.forename: Sayaka
authors.initials: S
authors.lastname: Nagao
authors.affiliation: Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Nishizaki
authors.affiliation: Department of Gastroenterological Surgery, Cancer Institute Ariake Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Hiki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000209:etiology; D016063:Blood Loss, Surgical; D061887:Conversion to Open Surgery; D003556:Cystitis / Q000209:etiology; D000069916:Endoscopic Mucosal Resection / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D005334:Fever / Q000209:etiology; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D046152:Gastrointestinal Stromal Tumors / Q000601:surgery*; D018589:Gastroparesis / Q000209:etiology; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D061646:Operative Time; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D015996:Survival Rate