Laparoscopic management of gastrointestinal stromal tumours

Gastrointestinal stromal tumours (GISTs) represent the most common non-epithelial tumour of the digestive tract. Laparoscopic approach may be considered ideal for the resection of these tumours. Their particular biological behaviour allows for a curative resection even without large resection margins and extensive lymphadenectomies.

Over a period of five years, eight patients benefited from laparoscopic resections (six patients with primary gastric GIST and two patients with small bowel GIST). Pathological features were analyzed including tumour size, surgical margin status, immunohistochemical staining profile, and tumour mitotic index. All cases were confirmed GISTs by immunohistochemical staining.

The mean age of the patients was 61.6 years (range 48-71 years). Of these patients, five initially presented to hospital with acute gastrointestinal haemorrhage (four cases) or occult bleeding (one case). Gastric or small bowel tumours were identified during subsequent investigation. A presumptive diagnosis of gastric GIST was made in gastric lesions based on endoscopic, ultrasonic, and CT scan characteristics. Small bowel tumours were identified and presumed to be GIST based on information gathered from video capsule endoscopy, enteroscopy and CT scan. Complete resection was obtained with laparoscopic approach in six cases, while in two cases resection was laparoscopically assisted, with added oncology safety margins as preoperative definitive diagnosis was not available. Tumours varied in dimension from 2.5 cm to 9 cm and their malignant risk score using Fletcher criteria was low in three cases, intermediate in three cases and high in two cases. Mean postoperative stay was 3.8 days and there were no complications, nor postoperative mortality. After a mean follow-up of 26 months (range 1 to 60 months) all patients are symptom free and free of recurrent disease.

A selective approach to laparoscopic resection of gastro-intestinal GISTs allows safe resection and very good results, on the condition that a clear diagnosis of GIST has been established on preoperative assessment. The laparoscopic feasible and safe considering the biological particularities of GIST, and it carries no additional risks.