Robotic gastric resection of large gastrointestinal stromal tumors

The stomach is the most common site for gastrointestinal stromal tumors (GIST) development. Surgical treatment consists of excision of the entire neoplastic mass, with sufficient surgical margins within healthy tissue. This can be achieved with different techniques ranging from wedge resections, typical gastric resections, right up to total gastrectomy. There aren't clear guidelines for the use of minimally invasive approach.

From January 2011 to April 2012, 5 patients with presumed preoperative diagnosis of GIST were treated by robotic surgery at the Unit of Surgery and Advanced Oncologic Therapies, Forlì Hospital, Forlì, Italy. We report operative techniques, perioperative outcomes and follow-up.

Lesions were localized at anterior wall of gastric antrum (N = 2) and near pyloric area (N = 3). Mean tumor size was 5 cm (range 4-7 cm). Surgical procedures were 5 distal gastrectomy. None intervention was converted to open surgery and there weren't major intraoperative complications. Median operative time was 240 min (range 210-300 min) and mean intraoperative blood loss was 96 ml (80-120 ml). All lesions had microscopically negative resection margins. Median follow-up was 13.5 months (range 12-15 months) with a disease-free survival rate of 100%.

Surgical robotic approach for large GISTs is feasibility and new evidences are needed to clarify the effective role of different surgical strategies.