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[Laparoscopic resection of submucosal tumors in gastric fundus]
Zhong-Wei Ke1, Jing-Li Cai, Dan-Lei Chen
1Minimally Invasive Surgery Center, Changhai Hospital, Second Military Medical University, Shanghai 200433, China. kezhongwei@medmail.com
Objective:
To investigate the feasibility and safety of extraluminal laparoscopic wedge resection (ELWR) in treating submucosal tumors in the gastric fundus.
Methods:
Clinical data of 84 patients underwent ELWR for submucosal tumors in the gastric fundus between September 2000 and December 2006 were reviewed and analyzed retrospectively. The four-portal operation procedures were carried out as follows: localization of the tumor, dissection of the omentum, mobilization of the gastric fundus and the upper polar of spleen, exposure of ECJ, and resection of the gastric fundus with Endo GIA.
Results:
The patients included 53 males and 31 females, age ranged from 32 to 78 years (mean, 59 years). The mean tumor diameter was (4.2 +/- 1.3) cm. The distance from the tumor edge to the ECJ was 1.1 - 3.0 cm. The operations were successful in all the 84 patients, with a mean operation time of (62.6 +/- 8.9) min and mean operative blood loss of (86.2 +/- 8.1) ml. No apparent tumor focus was left. No operation was converted to open surgery, and no significant postoperative complications occurred. The mean post-operative hospital stay was (5.6 +/- 0.5) days. The gastrointestinal function recovered within 36 h after operation in 66 cases (78.6%), and the patients returned to normal activity and restored oral feeding. The distance between the tumor and the resection margin was 0.7 - 2.5 cm from the ECJ [mean, (1.4 +/- 0.5) cm], and 2.5 - 6.0 cm from the other three sides [mean, (4.1 +/- 1.0) cm]. Of the 84 cases, 29 cases were diagnosed with leiomyoma, 51 cases different types of stromal tumor and 4 cases neurofibroma. The mean follow-up duration was (51.0 +/- 4.3) months, no recurrence or metastasis was found in the mean time.
Conclusions:
ELWR is a safe, simple and beneficial procedure for submucosal tumors in the gastric fundus, especially in the posterior wall near the ECJ. It avoids intraperitoneal infection, possible splenic injury and postoperative esophageal stenosis. In addition, the resection scope is not limited.