Benign Gastric Tumors Research Articles

Role of minimal invasive surgeries in gastric neoplastic diseases; how far we have come: an experience at tertiary centre

Background: Minimal invasive surgery (MIS) is a means of performing major operations through small incision, often using miniaturized, high tech imaging systems, to minimize the trauma of surgical exposure without compromising the quality of the surgical procedure. Upper gastro intestinal (GI) diseases constitute majority of gastro intestinal pathologies. With improved diagnostic and screening modalities, even in fatal diseases like carcinoma stomach (Ca stomach), MIS offers not only complete treatment but also improved quality of life by decreasing morbidity and mortality. This study attempts to explain our experience with MIS being performed at our institute.Methods: This study is hospital based, non-randomized prospective study carried out in the Department of Surgery, Govt. Cancer Hospital, Aurangabad from August 2014 to December 2016. Total 30 patients were included in study. All gastric neoplastic diseases operated by minimal invasive surgeries in patients of all age groups were included. All patients were operated under general anaesthesia. Post-operative pain scoring was done according to VAS scale. All patients were kept in ICU in immediate post-operative period for 2-3 days. Then patients were shifted to general ward once patients were clinically stable. Patients were discharged according to recovery. Hospital stay was prolonged in cases having complications. Patients were followed up post operatively after 1, 3 and 6 months and assessed on basis of symptoms.Results: Maximum patients belonged to the age group of 41-60 years. Mean age of patients operated for Gastrointestinal stromal tumours (GIST) was 57.5 years and Ca Stomach was 56.6 years. Mean operative time for laparoscopic gastrojejunostomy in our study was 150 min, for laparoscopic gastrectomy with gastro jejunal anastomosis was 230 min and for benign gastric tumours including GIST was 112 min. Type of anastomosis: Among 16 anastomoses, 2 oesophago - jejunal, 7 gastro - jejunal and 7 cases of gastro - gastric anastomosis were done. Jejuno - jejunal anastomoses are not included in this series. Both the oesophago - jejunal anastomoses were done by stapler method.Conclusions: It can be concluded that, minimal invasive surgeries for gastric diseases are feasible to perform. Blood loss, post-operative analgesia and hospital stay are less in laparoscopic procedures so it decreases over all hospital cost. Early post-operative recovery, decreased post-operative morbidity and avoiding unnecessary laparotomies are some of the other advantages of MIS. So, MIS should be considered as an alternative for open procedures in gastric disorders, for betterment of patient care.

Recurrent MALAT1-GLI1 oncogenic fusion and GLI1 up-regulation define a subset of plexiform fibromyxoma.

Plexiform fibromyxomas are rare neoplasms, being officially recognized as a distinct entity among benign mesenchymal gastric tumours in the 2010 WHO Classification of Tumours of the Digestive System. Characteristically, these tumours have a multinodular/plexiform growth pattern, and histologically contain variably cellular areas of bland myofibroblastic-type spindle cells embedded in an abundant myxoid matrix, rich in capillary-type vessels. As yet, the molecular and/or genetic features of these tumours are unknown. Here we describe a recurrent translocation, t(11;12)(q11;q13), involving the long non-coding gene metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) and the gene glioma-associated oncogene homologue 1 (GLI1) in a subgroup of these tumours. The presence of the fusion transcript in our index case was confirmed using polymerase chain reaction (PCR) on genomic DNA, followed by Sanger sequencing. We showed that the truncated GLI1 protein is overexpressed and retains its capacity to transcriptionally activate its target genes. A specific FISH assay was developed to detect the novel MALAT1-GLI1 translocation in formalin-fixed, paraffin-embedded (FFPE) material. This resulted in the identification of two additional cases with this fusion and two cases with polysomy of the GLI1 gene. Finally, immunohistochemistry revealed that the GLI1 protein is exclusively overexpressed in those cases that harbour GLI1/12q13 genomic alterations. In conclusion, overexpression of GLI1 through a recurrent MALAT1-GLI1 translocation or GLI1 up-regulation delineates a pathogenically distinct subgroup of plexiform fibromyxomas with activation of the Sonic Hedgehog signalling pathway. Copyright © 2016 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

150: Haematopoietic cell kinase activation promotes IL-11 dependent gastric cancer progression and invasion in mice

Gastric cancer has a high mortality rate associated with its late stage diagnosis. Although Gp130 knock-in mutant mice (gp130 F / F ) develop benign gastric tumours dependent upon IL-11-induced Stat3/mTORC activation with hallmarks of early stage intestinal-type gastric cancer in humans [1] , [2] , there is an urgent need to develop mouse models that mimic the progression from adenoma to carcinoma and metastasis. Macrophages are a major component of the tumour micro-environment, and their increased numbers and alternative activation is commonly associated with tumour progression and metastasis. Haematopoietic Cell Kinase (Hck) is a myeloid-specific Src family kinase that is involved in polarization of alternatively activated macrophages, which correlate with a poor prognosis for human gastric cancer. To establish whether aberrant Hck activation would induce tumourigenesis, Hck mutant mice that exhibit constitutive kinase activation (Hck Up / Up ) were crossed with gp130 F /+ mice that are predisposed to gastric tumour development. Surprisingly, the resulting gp130 F /+ ;Hck Up / Up compound mutants developed tumours similar to gp130[F/F] animals, while gp130 F /+ mice remained tumour-free. Furthermore, tumours in 9 month old gp130 F /+ ;Hck Up / Up mutants showed sub-mucosal invasion, which was not observed in gp130 F / F mice. Western blotting and immunohistochemical analysis revealed a significant increase in tumour cell proliferation in gp130 F /+ ;Hck Up / Up mutants compared to gp130 F / F animals, consistent with an increased abundance of the activated forms of Stat3, Erk, Akt and S6 cytoplasmic signalling proteins. While the total number of macrophages remained unaffected, qPCR analysis of purified tumour-associated macrophages from gp130 F /+ ; Hck Up / Up mice showed a significant increase in markers of alternative macrophage activation, including Il4 , Il13 , Arg1 and Ym1 when compared to cells from gp130 F / F animals. Furthermore, reciprocal adoptive transfer of Hck Up / Up bone-marrow into gp130 mutant recipients was sufficient to increase tumour burden and promote alternative macrophage polarisation. Collectively, our results demonstrate that aberrant Hck activation promotes polarisation towards alternative macrophage activation and confers an invasive gastric cancer phenotype.

Minimally Invasive Resection of Benign Gastric Tumors in Challenging Locations: Prepyloric Region or Gastroesophageal Junction

Benign gastric tumors in a prepyloric location or within 3 cm adjacent of the gastroesophageal junction (GEJ) are often challenging to resect using minimally invasive surgical techniques. The aim of this study was to examine the outcomes of patients who underwent minimally invasive enucleation or resection of benign gastric tumors at these difficult locations. The charts of patients undergoing minimally invasive resection of benign-appearing submucosal gastric tumors between June 2001 and December 2012 were reviewed. Data on tumor size and location, type of minimally invasive surgical resection, perioperative complications, 90-day mortality, pathology, and recurrence were collected. A total of 70 consecutive patients underwent laparoscopic resection of benign-appearing submucosal gastric tumors; there were 24 patients with lesions close to the GEJ and nine patients with lesions close to the prepyloric region. All lesions were successfully resected laparoscopically. For prepyloric tumors, surgical approaches included enucleation (n = 1), wedge resection (n = 2), and distal gastrectomy with reconstruction (n = 6). For tumors close to the GEJ, surgical approaches included enucleation (n = 16), wedge resection (n = 3), and esophagogastrectomy (n = 5). Complications in this series of 33 patients included late strictures requiring endoscopic dilation in three patients who underwent esophagogastrectomy. The 90-day mortality rate was zero. There were no recurrences over a mean follow-up of 15 months (range, 1 to 86 months). Minimally invasive enucleation or formal anatomic resection of submucosal tumors located adjacent to the GEJ or at the prepyloric region is safe and carries a low risk for tumor recurrence. Submucosal gastric lesions adjacent to the GEJ are amenable to laparoscopic enucleation or wedge resection unless they extend proximally into the esophagus. Prepyloric lesions often require formal anatomic resection with reconstruction.

Single-Port Versus Standard Laparoscopic Resection for a Gastric Benign Tumor in Gastroscopic-Laparoscopic Rendezvous Procedures Using a Laser-supported Diaphanoscopy

In this study, the standard laparoscopic technique versus the single-port approach was evaluated for the excision of benign gastric tumors using tissue-sparing laser-supported diaphanoscopy for localization. The first group consisted of 10 patients suffering from benign gastric tumors treated by standard laparoscopic resection. The second group included 10 patients treated using the single-port technique. All procedures were successfully completed. Histopathologic examination confirmed 15 cases of gastrointestinal stromal tumor, 3 cases of lipoma, 1 case of leiomyoma, and 1 case of high-grade dysplasia. There was no statistically significant difference for the operation times between both groups. Comparison of the largest and smallest resection margins achieved using the standard laparoscopic technique and single-port techniques showed no statistically significant differences between the groups. During follow-up, all patients were evaluated using the total body image and cosmesis questionnaire. Although scores of all body-image functions were similar, independent of laparoscopic technique, scores of all cosmetic functions in patients operated using the single-port technique showed a statistically significant higher degree of satisfaction with the scar (P<0185). The postoperative pain scores evaluated by the visual analog scale score were not significantly different between 2 groups. The single-port technique was found to be a feasible option for the resection of submucosal or mucosal tumors. However, this method is not intended to replace standard laparoscopic resections.

Prevalence and Predictive Factors of Malignant Potential in Resected Gastric Subepithelial Tumors

Background/Aims: EUS is a useful method to differentiate malignant from benign gastric subepithelial tumors (SETs) and to determine resection. However, this results in unnecessary resections of benign gastric SETs. The aim of our study is 1. to investigate clinical factors that may predict malignancy in gastric SET and 2. to determine how many of them have malignant potential in resected gastric SETs. Materials and Methods: We retrospectively identified 111 patients who underwent pathologic confirmation for gastric SETs by surgical (104/111, 93.6%) and endoscopic resection between February 2003 and April 2012 and analyzed the clinical, EUS findings and final pathologic diagnosis for these patients. Results: The diagnostic accuracy of EUS for SETs was 58.6% (51/87) and the rate of resection for benign SETs was 31.5% (35/111). In multivariate analysis, old age (≥65), as well as tumor size (≥2 cm) and location (upper or middle) were significant predictive factors for malignant potential of gastric SETs. Conclusions: One-third of endoscopic and surgical resections are performed for benign SETs. Patient’s age, tumor size, and location should be considered before resection of gastric SETs. In addition, more accurate tools for histologic confirmation should be developed in order to avoid unnecessary resection. (Korean J Helicobacter Up Gastrointest Res 2013;13:104-108)

Intragastric Endoscopic Assisted Single Incision Surgery for Gastric Leiomyoma of the Esophagogastric Junction

Single port laparoscopic surgery is becoming an alternative to conventional laparoscopic surgery as a new approach where all the conventional ports are gathered in just one multichannel port through only one incision. Appling this technical development, we have developed a new technique based on an intragastric approach using a single port device assisted by endoscopy (I-EASI: intragastric endoscopic assisted single incision surgery) in order to remove benign gastric lesions and GIST tumors placed in the posterior wall of the stomach or close to the esophagogastric junction or the gastroduodenal junction. We present a patient with a submucosal gastric tumor placed near the esophagogastric junction removed with this new approach.

Laparoscopic management of gastrointestinal stromal tumours: review at a Canadian centre

Laparoscopic wedge resection has been widely accepted for small benign gastric tumours. Large gastrointestinal stromal tumours (GISTs), however, can be difficult to manipulate laparoscopically and are at risk for capsule disruption, which can then result in peritoneal seeding. Some authors have suggested that large GISTs (> 8 cm) are best approached using an open technique. However, there has been no consensus as to what the cut-off size should be. We conducted one of the largest Canadian series to date to assess outcomes and follow-up of the laparoscopic management of GISTs. All patients with gastric GISTs presenting to Vancouver General Hospital and University of British Columbia Hospital between 2000 and 2008 were reviewed. Most lesions were resected using a wedge technique with closure of the stomach facilitated by an endoscopic linear stapling device. In all, 23 patients presented with GISTs; 19 patients underwent laparoscopic resection and, of these, 15 had a purely laparoscopic operation and 4 had a hand-assisted laparoscopic resection. Mean tumour size was 3.2 cm, with the largest tumour measuring 6.8 cm. There were no episodes of tumour rupture or spillage and no major intraoperative complications. All margins were negative. Mean follow-up was 13.3 (range 1-78) months. There was no evidence of recurrence or metastasis. The laparoscopic management of gastric GISTs is safe and effective with short hospital stays and good results over a mean follow-up of 13.3 months. We believe that it should be the preferred technique offered to patients.

Gastric Schwannoma or GIST: accuracy of preoperative diagnosis?

Mesenchymal cell tumours of the gastrointestinal tract are rare in western society. Gastrointestinal stromal tumour (GIST) is the most common of this group of tumours. Gastric schwannoma is rarer, accounting for only 0.2% of all gastric tumours and 4% of all benign gastric neoplasms. Indeed, schwannoma has only been recognized as a primary gastrointestinal tumour in the last 20 years through advances in pathological techniques. We report a rare case of gastric schwannoma, the endoscopic and radiological features of which were indistinguishable from a GIST. Due to the diagnostic uncertainty, surgical resection is the treatment of choice. Development of more reliable diagnostic methods, such as endoscopic core biopsy, may help the accuracy of preoperative diagnosis.

Laparoscopic Enucleation or Wedge Resection of Benign Gastric Pathology: Analysis of 44 Consecutive Cases

Laparoscopic resection of gastric submucosal tumors has been described, but the role of laparoscopy for tumors within the esophagus or near the gastroesophageal junction is not clearly defined. The aim of this study was to examine the outcomes of laparoscopic or thoracoscopic enucleation or wedge resection of benign gastric tumors. The charts of 44 patients who underwent minimally invasive resection of benign esophagogastric tumors were reviewed. Surgical approaches included thoracoscopic enucleation (n = 2), laparoscopic enucleation (n = 6), transgastric enucleation (n = 2), and laparoscopic gastric wedge resection (n = 34). There were 23 males with a mean age of 57 years. There was one conversion (2.5%) to laparotomy. Mean operative time was 97 ± 52 minutes. The mean length of hospital stay was 2.6 ± 2.0 days. One patient developed gastric outlet obstruction requiring Roux-en-Y reconstruction. There were no leaks and the 90-day mortality was zero. Pathology demonstrated gastrointestinal stromal tumor (n = 31), leiomyoma (n = 6), and other benign pathology (n = 7). There has been one tumor recurrence at a mean follow-up of 4.3 years. The laparoscopic approaches to local resection of gastric tumors are safe and feasible. The type of minimally invasive surgical approaches should be tailored based on the location and size of the lesion.

Intraluminal Resection of Gastric Tumors Using Intragastric Trocar Technique

We are presenting our experiences with combined laparoscopic and endoscopic approaches applied to the minimally invasive intragastric resection of the gastric tumors. We performed the above-mentioned combined intragastric resection in 7 patients. The intragastric resection is only used with posterior gastric wall tumors and tumors located near the cardia and the pylorus. For this approach, only 1 trocar is placed into the stomach to intragastrically introduce the endostapler. We used 2 trocars (5 mm) into the abdominal cavity for laparoscopy. We have performed the combined laparoscopic and endoscopic intragastric resection in 7 patients. The tumor size was 38 ± 7 mm (28-48 mm). The histology revealed 6 gastrointestinal stromal tumors and 1 leiomyoma. All 7 patients began eating and drinking on the second postoperative day. None of the patients showed any intraoperative or postoperative complications. The median postoperative hospital stay was 6.1 days (4-7 d). The combined intraluminal resection using 1 intragastric trocar of potential benign posterior gastric wall tumors, of tumors near the cardia and the pylorus is a safe surgical procedure with low invasivity and morbidity.

Clinical application of laparoscopic local resection for gastric tumors

Objective To evaluate laparoscopic local resection for the treatment of gastric tumors. Methods The clinical data of 78 patients who received laparoscopic local resection at the PLA General Hospital from February 2006 to January 2010 were retrospectively analyzed. According to the tumor site and free range, total laparoscopic gastrectomy was applied to 45 patients, laparoscopic local resection was applied to 22 patients, laparoscopic and endoscopic tumor resection was applied to 11 patients. The efficacies of the surgical approaches were investigated. Results Laparoscopic local resection was successfully performed on the 78 patients without conversion to open surgery. The mean operation time and operative blood loss were 75 minutes (range, 45-120 minutes) and 60 ml (range, 35-90 ml), respectively. The mean diameter of the tumor was (2.5±1.3)cm (range, 0.7-4.8 cm). No mortality or morbidity occurred postoperatively. The bowel function recovery time and the duration of hospital stay were 35 hours (range, 25-42 hours) and 7.5 days (range, 6-9 days), respectively. The results of postoperative pathological examination verified that 63 patients were with gastric stromal tumor, 11 patients were with benign gastric diseases, including 5 with gastric heterotopic pancreas, 2 with inflammatory pseudotumor, 2 with hyperplastic polyp, 1 with schwannomas and one with angioma. Four patients were with carcinoid, 3 carcinoids were located in mucous layer and 1 invaded into muscular layer. The median time of follow-up was 26 months, and no anastomotic stenosis or port-site metastasis was observed. Of the 63 patients with gastric stromal tumor, 2 were treated with imatinib mesylate, 1 had tumor recurrence and received reoperation. Conclusion Laparoscopic local resection is safe and feasible for the treatment of benign gastric neoplasms, stromal tumor and early gastric tumors. Key words: Gastric neoplasms; Laparoscopy; Resection

A Case of Gastric Lipoma Removed Using a Detachable Snare

Gastrointestinal lipoma is a benign tumor of mature adipose tissue, surrounded by fibrous capsule. They can be located anywhere in the gastrointestinal tract, but rarely in the stomach, especially at the cardia. Gastric lipoma accounts for approximately 2∼3% of all benign gastric tumors, and 5% of all gastrointestinal lipomas. Lipoma tends to have very low malignant potential, but if it induces symptoms like abdominal pain or hemorrhage, it needs to be removed. We report a case of gastric lipoma which was successfully removed by only using a detachable snare. A 72-years-old woman who had no specific symptom was found to have a submucosal tumor at cardia. During endoscopy, the fatty internal material accidently came out after tearing the mucosa with biopsy, and it was successfully removed using a detachable snare. (Korean J Helicobacter Up Gastrointest Res 2011;11:198200)

Gastric Schwannoma: Two Cases of Laparoscopic Resection and a Review of the Literature

Gastric schwannomas are a rare type of tumor, comprising only 0.2% of all gastric tumors, and only 4% of benign gastric neoplasms. They are typically slow growing and can originate from any nerve that contains a Schwann Cell sheath, most commonly from Auerbach's plexus. Because they can often be confused for more malignant variants of mesenchymal spindle cell tumors, such as gastrointestinal stromal tumors (GISTs), resection is the treatment of choice. We present two cases of patients who were found to have gastric masses that were both successfully removed laparoscopically. Patient 1 was a 68 year old female who presented with abdominal pain and abnormal liver function tests. Ultrasound confirmed gallstones and a CT scan identified a 3.6 cm x 4.2 cm mass arising in the gastric fundus. Endoscopic ultrasound identified a submucosal mass and biopsy suggested a schwannoma. Patient 2 was a 45 year female who presented with an 8 month history of abdominal pain which radiated to the right side of the abdomen. The initial impression was cholecystitis, however, ultrasound failed to show evidence of gallstones or inflammation. CT scan identified a 3 cm mass in the proximal body of the stomach, which endoscopic ultrasound confirmed as a submucosal mass. Postoperative tissue stainings in both cases were positive for S-100 and negative for smooth muscle actin (SMA) leading to the diagnosis of gastric schwannoma. Hospital length of stay was 4 days for patient 1 and 3 days for patient 2 and neither patient experienced any post operative morbidity. We review the literature of gastric schwannomas, including the rising incidence of successfully resecting these tumors through laparoscopic techniques.

Induction and Down-regulation of Sox17 and Its Possible Roles During the Course of Gastrointestinal Tumorigenesis

The activation of Wnt/beta-catenin signaling causes the development of gastric and colon cancers. Sox17 represses Wnt/beta-catenin signaling and is down-regulated in colon cancer. This study was designed to elucidate the role of Sox17 during the course of gastrointestinal tumorigenesis. Sox17 expression was examined in gastrointestinal tumors of mouse models and humans. The roles of Sox17 in gastric tumorigenesis were examined by cell culture experiments and by construction of Sox17 transgenic mice. Sox17 was induced in K19-Wnt1/C2mE mouse gastric tumors and K19-Wnt1 preneoplastic lesions, where Wnt/beta-catenin signaling was activated. Consistently, Wnt activation induced Sox17 expression in gastric cancer cells. In contrast, Sox17 was rarely detected by immunohistochemistry in gastric and colon cancers, whereas strong nuclear staining of Sox17 was found in >70% of benign gastric and intestinal tumors. Treatment with a demethylating agent induced Sox17 expression in gastric cancer cells, thus indicating the down-regulation of Sox17 by methylation. Moreover, transfection of Sox17 in gastric cancer cells suppressed both the Wnt activity and colony formation efficiency. Finally, transgenic expression of Sox17 suppressed dysplastic tumor development in K19-Wnt1/C2mE mouse stomach. Sox17 plays a tumor suppressor role through suppression of Wnt signaling. However, Sox17 is induced by Wnt activation in the early stage of gastrointestinal tumorigenesis, and Sox17 is down-regulated by methylation during malignant progression. It is therefore conceivable that Sox17 protects benign tumors from malignant progression at an early stage of tumorigenesis, and down-regulation of Sox17 contributes to malignant progression through promotion of Wnt activity.

Laparoscopic resection of gastric GIST and benign gastric tumours: evolution of a new technique

Gastrointestinal stromal tumours (GIST) are a distinctive group of mesenchymal neoplasm of the gastrointestinal tract that are best treated by surgical excision without tumour disruption and with a clear resection margin to prevent disease recurrence. However, delivering a posterior gastric tumour through an anterior gastrotomy, laparoscopically, can sometimes risk tumour rupture. We have devised a new technique to avoid this complication. With the patient in supine position, under a general anaesthetic and using a standard three ports, an anterior gastrotomy was performed and posterior tumour identified. An endobag was introduced through a 10-mm port. The retractable metal ring in endobag was closed around the base of the tumour. The tumour was gently lifted, and an endoscopic linear stapler introduced through another 12-mm port was used to resect the tumour with a cuff of normal gastric tissue. Data were analysed on 22 consecutive patients with gastric GIST who were treated laparoscopically. Intra-operative endoscopy was performed in all cases to aid localisation. There were 16 posterior tumours, of which 11 were operated by the new technique (using endobag and linear stapler) while 5 were dealt with using the old method (resection and suturing of defect). Median operating time for the new versus old technique was 70 versus 120 min (p < 0.002, Mann-Whitney test). There was no tumour disruption or incomplete resection margin using the new technique for posterior tumours. There were six anterior tumours treated by laparoscopic resection and suture closure of the defect. There was no significant difference in median operating time for anterior versus posterior tumours (80 vs. 75 min). Gastric GIST can be safely and efficiently resected laparoscopically without rupture or disruption with an adequate resection margin with this technique.

Endoscopic-sonographic diagnosis of the stomach wall

Endoscopic ultrasonography makes it possible to measure and examine the wall of the upper gastrointestinal tract. It complements endoscopic visualization of the surface with analysis of the wall layers. Endoscopic ultrasound imaging reveals five different layers. Preliminary results indicate that benign gastric tumours can be distinguished from infiltrating gastric carcinoma. The extent and adjoining reaction of a gastric ulcer can also be visualized. Endoscopic ultrasonography of the stomach is a method of investigation that can be further developed and already shows considerable diagnostic potential.

Symptomatic subserosal gastric lipoma successfully treated with enucleation

Gastric lipomas are rare tumors, accounting for 2%-3% of all benign gastric tumors. They are of submucosal or extremely rare subserosal origin. Although most gastric lipomas are usually detected incidentally, they can cause abdominal pain, dyspeptic disorders, obstruction, invagination, and hemorrhages. Subserosal gastric lipomas are rarely symptomatic. There is no report on treatment of subserosal gastric lipomas in the English literature. We present a case of a 50-year-old male with symptomatic subserosal gastric lipoma which was successfully managed with removal, enucleation of lipoma, explorative gastrotomy and edge resection for histology check of gastric wall. The incidence of gastric lipoma, advanced diagnostic possibilities and their role in treatment modalities are discussed.

Minimally Invasive Surgery for Gastric Stromal Cell Tumors: Intermediate Follow-up Results

Laparoscopic wedge resection of the stomach (LWS) has become the treatment of choice for patients with benign gastric tumors. The technical consideration and long-term follow-up data of LWS for gastrointestinal stromal tumors (GISTs) of the stomach are limited. We present our experience of 28 LWSs for gastric GISTs with a mean follow-up of 43 months. From October 1995 to December 2002, we successfully performed 28 LWSs for 29 patients with GISTs of the stomach, and one patient needed conversion to laparotomy because of suspected bowel injury when establishing pneumoperitoneum. Patient demographics, perioperative parameters, and outcomes of the 28 patients were assessed retrospectively. The tumors were located in the upper third of the stomach in 13 patients, in the middle third, in eight patients, and in the lower third, in seven patients. The mean size of tumors was 3.4 +/- 1.6 cm in diameter. The duration of operation ranged from 95 to 390 minutes: 189.6 +/- 79.5 minutes with the stapler method and 194.3 +/- 50.5 minutes with the hand-sewn method (P = 0.8870). No blood transfusion was given in the perioperative period in all cases. Cholecystectomy in three patients and repair of hiatal hernia in one patient were performed during the same operation. The oral intake was restored at the third to fourth postoperative days. The hospital stay ranged from 3 to 11 days (mean, 6.7 +/- 1.8 days). The follow-up period ranged from 12 to 95 months (mean, 43.3 +/- 23.5 months, median 42 months). There has been no evidence of tumor recurrence, including one patient with microscopic invasion of section margin. LWS can be performed safely with a satisfactory remission rate for patients with gastric stromal cell tumors.

GASTRIC LIPOMA SUCCESSFULLY REMOVED BY LAPAROSCOPIC INTRAGASTRIC SURGERY

Lipomas are found very rarely in the stomach, where they account for only 3% of benign gastric tumors. Here, we report a case of large gastric lipoma removed successfully by laparoscopic intragastric surgery. A 45‐year‐old woman with no symptoms was incidentally diagnosed with a yellowish submucosal gastric tumor, about 3 cm in diameter, in the prepyloric antrum by upper gastrointestinal endoscopy. Pathological findings of biopsy specimens showed no evidence of malignancy. Computed tomography showed an ovoid and well‐circumscribed intramural mass, measuring 35 mm, which was of fat density. These findings suggested that the tumor was a lipoma that we felt should be treated, because large lipomas can give rise to gastrointestinal bleeding. We performed a laparoscopic intragastric enucleation for this tumor. Postoperatively, the tumor was confirmed pathologically to be a lipoma of the stomach. This laparoscopic procedure for benign non‐epithelial gastric tumors, such as lipomas, presented here is technically feasible, safe, and less stressful for the patient than gastrectomy.