Clinical efficacy of modified totally laparoscopic intra-gastric surgery for submucosal tumors adjacent to the gastric cardia or pylorus

Abstract

Objective To explore the clinical efficacy of modified totally laparoscopic intra-gastric surgery for the treatment of submucosal tumors adjacent to the cardia or pylorus. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 48 patients with gastric submucosal tumors adjacent to the cardia or pylorus between September 2014 and March 2018 were collected. There were 22 males and 26 females, aged from 38 to 78 years, with an average age of 58 years. Patients were performed multi-port or single-port modified laparoscopic intra-gastric surgery. Observation indicators: (1) surgical treatments; (2) postoperative recovery; (3) results of postoperative pathological examination; (4) follow-up. Patients were followed up by outpatient examination and telephone interview to detect the postoperative complications and tumor metastasis and recurrence up to June 2018. Measurement data with normal distribution were expressed as Mean±SD and measurement data with skewed distribution were described as M (range). Count data were represented as absolute number or percentage. Results (1) Surgical treatments: 48 patients underwent modified totally laparoscopic intra-gastric surgery successfully, including one patient combined with proximal gastrectomy, without conversion to open surgery. Of the 48 patients, 43 underwent multi-port modified laparoscopic intra-gastric surgery and 5 underwent single-port modified laparoscopic intra-gastric surgery. The operation time and volume of intraoperative blood loss were 68 minutes (range, 45-110 minutes) and 20 mL (range, 5-100 mL). The oncologic evaluation of 48 patients: 48 patients had complete resection of tumors, without tumor rupture. The tumor diameter and distance from margin to tumor were 32 mm (range, 20-40 mm) and 6 mm (range, 5-10 mm). (2) Postoperative recovery: the time for initial oral intake and duration of postoperative stay were 2.8 days (rang, 1.0-5.0 days) and 5.3 days(range, 3.0-11.0 days). There were 4, 3, 1 and 1 patients complicated with surgical infection, delayed gastric emptying, sub-phrenic hydrops and digestive leakage respectively in the 48 patients. (3) Results of postoperative pathological examination: the distance from tumor margin to gastric cardia or pylorus, tumor diameter, circumferential resection margin were 15 mm (range, 0-30 mm), 24 mm (range, 10-65 mm), 6 mm (range, 5-10 mm), respectively. Growth patterns of cancer in the 48 patents included 27 of intraluminal type, 12 of intermural type, 9 of mixed type. Pathological types of 48 patients: there were 26 patients with leiomyoma, 9 with gastrointestinal stromal tumor, 4 with other rare tumors, 2 with carcinoid, 2 with mucosa-associated lymphoma, 2 with inflammatory fibrous polyps, 2 with gastritis cystica profunda, 1 with ectopic pancreas. (4) Follow-up: 41 of the 48 patients were followed up for 3-48 months, with a median follow-up time of 22 months. No tumor recurrence was detected in 37 of 41 patients by 3 times of gastroscopy and no stenosis or dysfunction of cardia or pylorus was detected in 39 patients by 2 times of upper gastrointestinal imaging (one patient undergoing two examinations) . During the follow-up, there was no surgery-related complication or tumor-specific death. Conclusion Modified totally laparoscopic intra-gastric surgery is safe and feasible for the treatment of gastric submucosal tumors adjacent to the cardia or pylorus. Key words: Submucosal tumors; Intra-gastric surgery; Cardia; Pylorus; Laparoscopy