Abstract
Sa1593 Comparing the Feasibility and Efficacy of Combined Endoscopic and Transumbilical Single-Port Laparoscopic Surgery With Standard Laparoscopic Resection of Gastric Stromal Tumors Wen LI*, Zikai Wang, Baoqing Jia, Xiaohui Du, Xiaopeng Wang, Tingting Huang, Xuan Su, Lili Wu, Xiuxue Feng Gastroenterology and Hepatology, the Chinese PLA General Hospital, Beijing, China; Department of Oncological Surgery, the Chinese PLA General Hospital, Beijing, China; Department of General Surgery, the Chinese PLA General Hospital, Beijing, China Background: Complete endoscopic or laparoscopic resection of gastric stromal tumors (GST) in the cardia & fundus is only partially feasible. A combined endoscopic-laparoscopic approach has been recently recognized as the favorable modality for these lesions. Aims: To assess the feasibility and efficacy of combined endoscopic and transumbilical single-port laparoscopic surgery (CETSLS) for the GST. Methods Between April, 2010 and July, 2013, 14 patients with GST were assigned to undergo CETSLS (n Z 7) and standard laparoscopic surgery (SLS) (n Z 7) at the Chinese PLA general hospital. The subjects undergiong CETSLS were managed with laparoscopy-assisted endoscopic techniques (i.e. endoscopic snare resection, endoscopic mucosal resection and endoscopic submucosal dissection) or endoscopy-assisted laparoscopic techniques (i.e. laparoscopic gastric wedge resection). Several parameters were analyzed: operation time, conversion rate, operative complications, pain scores, cost and duration of hospital stay, cosmetic satisfaction and follow-up evaluation. Results: There was no difference in the age, gender and indications for CETSLS and SLS groups. All lesions were located in the gastric cardia/ fundus, They were confirmed to be GST on immunohistochemical staining and showed similar mean diameter. CETSLS was successfully carried out in 85.7% (6/7) of our patients with one case requiring conversion to open surgery due to intraoperative bleeding. However, there was no conversion in the SLS group. The mean operative time was similar in both groups (108.0 59.2 vs. 164.3 49.3 minutes: P Z 0.09). The intra-operative blood loss was lower in CETSLS than SLS group (25.0 15.2 ml vs. 74.3 32.6 ml: P Z 0.006). Complete resection rate was 100%. It was achieved without serious complications in both groups. Despite a shorter postoperative hospitalization time in the CETSLS group (5.7 1.4 vs. 8.9 2.8 days, PZ 0.03), the cost of hospitalization was almost similar (40942.8 11158.6 vs. 57246.7 16049.4 RMB, P Z 0.06). There was no re-admission or tumor recurrence during a median follow-up of 26 months (range, 4 43 months). Conclusions: CETSLS is a feasible and effective technique, which offers superior cosmesis during resection of the GST.
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