Totally laparoscopic intragastric surgery for gastric submucosal tumors located near the esophagogastric junction

Abstract

Background: Laparoscopic partial gastrectomy (LAP) is a standard treatment for gastric submucosal tumors (SMTs). However, for SMTs located in the special parts such as the esophagogastric junction (EGJ) or the lesser curvature, LAP is difficult to approach with considerable risk of causing deformity or stenosis, tumor must be exposed via gastrotomy or handled by laparoscopic intragastric surgery (LIGS). We designed the totally laparoscopic intragastric surgery (T-LIGS), and describe this procedure and its clinical outcomes for gastric SMTs. Methods: Fourteen consecutive patients with gastric intraluminal SMTs located near the EGJ underwent T-LIGS at our center from January 2012 to December 2014. The clinicopathological results of these 14 cases were analyzed. Results: T-LIGS was successfully performed on all the patients. The mean operation time was 71.1±22.2 min (range, 45–110 min) and the mean blood loss was 9.3±7.0 mL (range, 5–30 mL). There was no death or intraoperative complications in our series. One patient experienced a postoperative complication of gastroparesis, one patient experienced surgical site infection, both recovered after conservative treatment. The mean postoperative length of hospital stay was 6.6±1.7 days (range, 5–11 days). All patients received complete resection with a negative margin. Histopathologic diagnoses were gastrointestinal stromal tumor (GIST) in nine cases, neurofibroma in two, neuroendocrine tumor (NET) in two, and mucosa associated lymphoid tissue lymphoma in one. There was one case of stenosis of the EGJ, and no case of tumor recurrence, during a mean follow-up of 13.9±7.4 months (range, 6–30 months). Conclusions: T-LIGS is a safe, feasible, and effective procedure, its suitable for treatment of gastric SMTs located near the EGJ.