Laparoscopic treatment of gastric tumors

To assess the use of different laparoscopic approaches in the management of gastric tumors based on tumor type and location.

Between March 2002 and June 2005, 23 consecutive patients with gastric lesions were treated with laparoscopy procedures. Six patients presented with stromal tumors, 5 with benign lesions, and 12 with resectable gastric cancers.

The patients were 13 men and 10 women, mean age 66.2 +/- 11.1 years (range, 29-84 years). Five laparoscopic gastric wedge resections, 6 intragastric submucosal resections, and 12 gastrectomies (10 subtotal and 2 total) were performed. Mean operative time was 49.1 +/- 18.8 minutes (range, 30-85 minutes) in the gastrointestinal stromal tumors and 64.1 +/- 19.2 minutes (range, 45-90 minutes) in benign tumors. Gastrectomy required an average of 197.6 +/- 36.9 minutes (range, 130-260 minutes). The mean times were 142.5 +/- 9.6 minutes in the subtotal gastrectomy group with extracorporeal anastomosis and 190.8 +/- 20.1 minutes when the anastomosis was totally laparoscopic (P < 0.002). All procedures were completed laparoscopically and there were no intraoperative complications. There were four postoperative complications: one wall hematoma secondary to the introduction of a trocar, one prolonged ileus, one intra-abdominal abscess, and one esophagojejunal leakage. Gastrointestinal stromal tumor patients were discharged after a mean 5.8 +/- 1.3 days; patients with benign pathology after 5.2 +/- 0.9 days, and gastric cancer patients after 10.7 +/- 7.3 days (range, 6-28 days). The mean number of dissected lymph nodes in gastric cancer was 21.3 (range, 16-31).

Laparoscopic treatment of gastric lesions is technically feasible and safe. Compared to conventional surgery, it offers the advantages of low invasiveness and improved quality of life.