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Laparoscopic resection of small gastric submucosal tumors
Ki-Jin Ryu1, Sae-Rom Jung, Jung-Soon Choi
1Department of Surgery, Korea University College of Medicine, Seoul, Korea.
Background:
No consensus exists regarding the necessity of operative resection for patients with small, asymptomatic gastric submucosal tumors (SMTs). The purpose of this study is to evaluate clinical outcomes of resection by minimally invasive surgery.
Methods:
The medical records of 20 consecutive patients who had undergone laparoscopic or robotic wedge resection for small (<5 cm) gastric SMTs between March 2008 and February 2009 were reviewed. Operative indications included all SMTs unquestionably visible by endoscopy, irrespective of symptoms. The operative procedures, clinicopathologic features, and operative results were assessed.
Results:
Out of a total of 20 patients, 17 were asymptomatic, and 3 presented with vague abdominal discomfort. One patient had two tumors, therefore 21 total lesions were resected and evaluated (19 by laparoscopy and 2 by robotic procedures). There were 12 exogastric and 9 transgastric wedge resections. Mean operative time was 84 ± 28 min, and mean length of hospitalization was 4.7 ± 1.6 days. There were no major peri- or postoperative complications or mortalities. Mean tumor size was 2.4 ± 1.2 cm (range 0.6-4.8 cm). All lesions had microscopically negative resection margins. There were 16 gastrointestinal tumors (GISTs) and 5 other benign lesions. Fifteen of the GISTs had mitotic count (MC) <5 per 50 high-power fields (HPFs), and one lesion measuring 2.5 cm in size had MC of 38 per 50 HPFs.
Conclusions:
Small size cannot guarantee a specific malignant risk for gastric SMTs. Laparoscopic/robotic wedge resection is safe and effective in treating small, asymptomatic lesions. Therefore, an active surgical approach should be considered for management of patients with small gastric SMTs.
Insights
Minimally invasive surgery for small gastric submucosal tumors (SMTs) is safe and effective. This approach should be considered for managing these lesions, as small size does not rule out malignant potential.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Uncertainty exists regarding the necessity of operative resection for small, asymptomatic gastric submucosal tumors (SMTs).
- Evaluating clinical outcomes of minimally invasive resection for gastric SMTs is crucial.
Purpose of the Study:
- To assess the safety and efficacy of laparoscopic or robotic wedge resection for small gastric SMTs (<5 cm).
- To evaluate clinical outcomes, including operative results and complications, of minimally invasive surgery for gastric SMTs.
Main Methods:
- Retrospective review of 20 patients undergoing laparoscopic or robotic wedge resection for gastric SMTs (March 2008-February 2009).
- Inclusion criteria: SMTs visible by endoscopy, regardless of symptoms.
- Assessment of operative procedures, clinicopathologic features, and outcomes.
Main Results:
- 21 lesions resected from 20 patients (19 laparoscopic, 2 robotic).
- Mean operative time: 84 ± 28 min; mean hospitalization: 4.7 ± 1.6 days.
- No major complications or mortalities; all resections had negative margins. 16 gastrointestinal stromal tumors (GISTs) and 5 benign lesions identified.
Conclusions:
- Small gastric SMTs (<5 cm) can harbor malignant potential, irrespective of size.
- Laparoscopic/robotic wedge resection is a safe and effective treatment for small gastric SMTs.
- An active surgical approach is recommended for managing patients with small gastric SMTs.