LAPAROSCOPIC WEDGE RESECTION OF GASTRIC STROMAL TUMORS

Abstract

Background: Large gastric stromal tumors that are not suitable for endoscopic polypectomy usually necessitate open surgical resection. Laparoscopic wedge resection of gastric stromal tumors has been demonstrated to be a feasible approach by small series case reports.Patients and method: Patients with gastric stromal tumours were diagnosed by upper endoscopy and CT scan were performed. Hemostatic procedure was performed for bleeding lesions when applicable. All patients underwent diagnostic laparoscopy and laparoscopic ultrasound examination to assess the lesions and rule out metastatic disease. Extragastric closed technique was employed for stromal tumors located at the body of stomach, where they are mobile and surrounded by ample amount of redundant normal gastric wall. Transgastric approach via anterior gastrototomy was employed for lesions near the gastro‐oesophageal junction, fundus and close to the greater and lesser omentum, where there were not adequate surrounding stomach wall. Operative time, resumption of full diet, analgesic requirement, post‐operative stay, morbidity and mortality were analysed prospectively.Results: From June 1995 to February 2000, 31 patients with gastric stromal tumors underwent laparoscopic wedge resection in our unit. There were 16 male and 15 female patients, aged 40 to 84 (mean = 64). Average operative time was 82 (45–180) minutes. Extragastric closed techniques were employed for 7 patients and the remaining lesions were extirpated via gastrotomy. Two patients with fundal lesions required conversion to open procedure because of adhesions to the posterior abdominal wall. Patients required 2 doses of post‐operative intramuscular pethidine for pain control and 6 days (median) to resume full diet. The median post‐operative stay was 6 days. One patients developed stroke on post‐operative day 3. Another patient developed diffuse peritoneal metastasis 30 months after the initial procedure. In all cases, clear resection margins were confirmed on histology.In conclusion: Laparoscopic wedge resection of gastric stromal tumors is safe and feasible approach with low perioperative morbidity.