Laparoscopic Wedge Resection Research Articles

Colonoscopy Assisted Laparoscopic Wedge Resection for Colonic Lesions: Impact on Quality of LifE: Results from the LIMERIC Study.

The LIMERIC study has proven that colonoscopy-assisted laparoscopic wedge resection effectively and safely removes benign colonic lesions unsuitable for endoscopic removal, thereby avoiding the need for major surgery. To evaluate the impact of colonoscopy-assisted laparoscopic wedge on health-related quality of life of patients who participated in the LIMERIC study. Prospective multicenter study. The LIMERIC study was performed between 2016 and 2020 in 13 Dutch hospitals. EQ-5D-5L questionnaires were administered at baseline and 3 months after the procedure. Patients with incomplete pre- or postoperative questionnaires or those undergoing combined interventions were excluded from the intention-to-treat analysis. Those for whom CAL-WR was not feasible or who underwent completion surgery were excluded from the per-protocol analysis. Colonoscopy-assisted laparoscopic wedge for either (1) colon polyp unsuitable for endoscopic resection; (2) non-lifting residual or recurrent polyp within scar tissue following previous polypectomy; or (3) Rx/R1 endoscopic removal of a low-risk pT1 colon carcinoma. Three-month health-related quality of life. Colonoscopy-assisted laparoscopic wedge did not affect health-related quality of life in the per-protocol analysis (n = 56), or in the intention-to-treat analysis (n = 67). The majority of patients reported no change in health status (57%). No significant differences were observed in the distribution of responses across all 5 dimensions before and after colonoscopy-assisted laparoscopic wedge. Patients' self-rated EQ-VAS was also unaffected by colonoscopy-assisted laparoscopic wedge, with a median VAS score of 82.5 at baseline and 80 after surgery in the per-protocol analysis (p = 0.63). Solely a patient-reported outcome measure evaluating global health-related quality of life was used, rather than one specifically assessing disease-related quality of life, such as the QLQ-CR29. Colonoscopy-assisted laparoscopic wedge has no significant impact on the health-related quality of life in patients with benign colonic lesions and should therefore be considered before major surgery is performed. See Video Abstract.

Comparative Assessment of Laparoscopic and Endoscopic Cooperative Surgery with Laparoscopic Wedge Resection for the Treatment of Gastric Submucosal Tumors

Abstract Background The most commonly performed surgical resection technique for gastric submucosal tumors (gSMTs) is laparoscopic wedge resection (LWR). Notably, laparoscopic and endoscopic cooperative surgery (LECS) is a surgical procedure that combines laparoscopic gastric resection with an endoscopic submucosal dissection for the local resection of gastric tumors, which provides appropriate and minimal surgical resection margins. Methods Seventy-nine gSMT patients who underwent surgical resection at our department between January 2004 and January 2023 were retrospectively assessed. LWR and LECS were performed in 61 and 18 patients, respectively. Clinicopathological features and short-term surgical outcomes were assessed between the two groups. A 2:1 propensity score matching was performed to mitigate the effects of selection biases. Regardless of the surgical procedure, all the patients underwent curative resection with negative margins. Results The LWR and LECS groups included 24 and 12 patients, respectively. The mean operative duration was significantly shorter in the LWR group than in the LECS group (LWR, 131.1 min; LECS, 195.2 min; p < 0.05). The mean ratio of tumor diameter to resected specimen diameter was significantly higher in the LECS group than in the LWR group (LWR, 60.3%; LECS, 78.9%; p < 0.05). The mean ratio of tumor area to resected specimen area was significantly higher in the LECS group than in the LWR group (LWR, 44.7%; LECS, 66.3%; p < 0.05). Conclusion LECS was performed safely with a minimal and optimal safety margin compared with LWR. The findings suggest that LECS can be a feasible option for the treatment of gSMTs.

Long-Term Efficacy of Single-Incision Laparoscopic Intragastric Resection in Treating Gastrointestinal Stromal Tumors.

Gastrointestinal stromal tumors (GISTs), the most common mesenchymal tumors in the gastrointestinal tract, are increasingly treated with minimally invasive surgeries. Developed techniques include laparoscopic, endoscopic, and hybrid methods for gastric GIST resection. Our study, focusing on single-incision laparoscopic intragastric resection for gastric GISTs, aims to evaluate its safety, efficacy, and long-term outcomes. In a retrospective study of GIST surgery involving 14 patients who underwent single-incision laparoscopic intragastric resections, we analyzed and compared their preoperative demographics, American Society of Anesthesiologists (ASA) scores, tumor size, neoadjuvant treatment, operation duration, hospital stay, mitotic and Ki-67 indexes, and histological features with those of patients who underwent open and laparoscopic wedge resections, to assess the impact on both survival and disease-free survival. Average operation time was 93.07 minutes (range 81-120 minutes). Average blood loss: 67 ± 20 mL (range 40-110 mL). Postoperative hospital stay averaged 6.79 days (range 4-16 days). Strong correlations were observed between preoperative and pathological tumor sizes (P = .001, P < .001). Survival analysis indicated a significant association with ASA scores (P = .031), but not with mitotic index, Ki-67, or tumor size. Average survival was 80.57 months, with no recurrence or metastasis during follow-up. Based on our experience, the single-incision laparoscopic intragastric resection method emerges as a highly efficient, timesaving, and gentle oncological procedure, providing a safe and minimally invasive alternative resulting in shorter hospital stays and excellent long-term outcomes with minimal recurrence. For more definitive conclusions, larger, multicenter, and prospective studies are recommended.

Endoscopic Treatment for Gastric Subepithelial Tumor.

Most gastric subepithelial tumors (SETs) are asymptomatic and are often incidentally discovered during endoscopic procedures conducted for unrelated reasons. Although surveillance is sufficient for the majority of gastric SETs, certain cases necessitate proactive management. Laparoscopic wedge resection, although a viable treatment option, has its limitations, particularly in cases where SETs (especially those with intraluminal growth) are not visualized on the peritoneal side. Recent advances in endoscopic instruments and technology have paved the way for the feasibility of endoscopic resection of SETs. Several promising endoscopic techniques have emerged for gastric SET resection, including submucosal tunneling endoscopic resection, endoscopic full-thickness resection (EFTR), laparoscopic and endoscopic cooperative surgery (LECS), and non-exposure EFTR (non-exposed endoscopic wall-inversion surgery and non-exposure simple suturing EFTR). This study aimed to discuss the indications, methods, and outcomes of endoscopic therapy for gastric SETs. In addition, a simplified diagram of the category of SETs according to the therapeutic indications and an algorithm for the endoscopic management of SET is suggested.

A mathematical solution to an anatomical problem in laparoscopic wedge resections of postero-superior liver segments

A mathematical solution to an anatomical problem in laparoscopic wedge resections of postero-superior liver segments

SAT209 Metastatic Parathyroid Carcinoma And The Challenge Of Maintaining Calcium Balance

Abstract Disclosure: K.M. Tuna: None. S. Badour: None. E.P. Monsour: None. G. Acosta Garcia: None. D. Barb: None. Background: Parathyroid carcinoma is a rare malignancy representing less than 1% of all parathyroid disorders. Presentation is significant for highly elevated calcium (Ca) and parathyroid hormone (PTH) levels, and usually a palpable neck mass (&amp;gt;3cm). Diagnosis is often made after surgery based on histopathology findings. The primary treatment modality remains surgical, but there is no effective approach for metastatic disease. Case presentation: A 51-year-old woman initially presented with multinodular goiter and compressive symptoms in 2008. Workup showed an elevated Ca of 14.4 mg/dl (normal 8.4-10.2 mg/dl) and PTH of 502 pg/ml (normal 12-88 pg/ml) while albumin 4.3 g/dl (normal 3.5-5.2 g/dl) and normal thyroid function tests. Radioactive Iodine uptake scan showed a 4.4 cm cold nodule on the right inferior pole. Sestamibi scan showed increased left upper pole activity. The patient underwent total thyroidectomy with surgical exploration for parathyroid adenoma. Pathology showed right intrathyroidal parathyroid carcinoma with lymphovascular invasion. The patient was lost to follow-up until 2022 when she was admitted with severe hypercalcemic crisis (Ca 15.8 mg/dl, Albumin 3.9 g/dl, and PTH 805 pg/ml). The patient was treated with IV fluids, calcitonin, and multiple rounds of bisphosphonates, and was then maintained on high-dose cinacalcet due to refractory and recurrent hypercalcemia. Repeat Sestamibi and neck US were unremarkable, although CT chest showed a 1.3 cm nodule in the right lower lung lobe. This was not FDG- nor DOTATATE-avid on PET-CT. The patient underwent laparoscopic wedge resection of the right lung nodule, and the pathology was consistent with metastatic parathyroid carcinoma. Her Ca and PTH levels normalized immediately after surgery (PTH decreased from 883 to 27 pg/ml) suggesting possible remission. Prior to discharge, she was started on oral calcium and vitamin D due to dropping Ca levels and clinical signs of hungry bone syndrome. She was readmitted one month later for preexistent heart failure exacerbation and declining renal function. Her PTH was noted to be elevated again, although Ca remained normal, raising concern for recurrent or persistent disease. However, the patient’s renal impairment and lung effusion limited further imaging. Ca and PTH were monitored frequently during hospitalization and weekly after discharge. PTH levels peaked at 634 pg/ml and then dropped to 127 pg/ml without intervention. Ca remained in the normal range while on calcium citrate and calcitriol. Conclusion: Treatment of metastatic parathyroid carcinoma remains a challenge. Mortality is secondary to complications of hypercalcemia; therefore, controlling calcium levels should be the main therapeutic goal. Hungry bone syndrome should be considered after surgery. Metastatic disease may occur even after 20 years; thus, lifelong close monitoring is indicated. Presentation: Saturday, June 17, 2023

Progress of laparoscopy and endoscopy cooperative surgery for early colorectal tumors

Cooperative laparoscopic or robotic-endoscopic surgery has emerged as a promising approach for the treatment of early-stage colorectal cancers that are difficult to treat with endoscopic techniques alone. Cooperative surgery allows organ and function preservation by complementing the advantages of each modality, providing minimally invasive, precise and personalized treatment options. Laparoscopic-endoscopic cooperative surgery includes laparoscopic-assisted endoscopic resection, combined laparoscopic-endoscopic full-thickness resection, endoscopic-assisted laparoscopic wedge resection, endoscopic-assisted laparoscopic segmental resection, and laparoscopic-endoscopic cooperative surgery with sentinel lymph node dissection. Nearly three decades of clinical research and practice have demonstrated the safety and efficacy of laparoscopic and endoscopic cooperative surgery in the treatment of colorectal tumors. With the progress of the minimally invasive concept, the development of minimally invasive technology and the innovation of minimally invasive equipment, laparoscopy and endoscopy cooperative surgery is expected to have a proper place in the treatment of colorectal tumors.

Limited wedge resection for T1 colon cancer (LIMERIC-II trial) – rationale and study protocol of a prospective multicenter clinical trial

BackgroundThe sole presence of deep submucosal invasion is shown to be associated with a limited risk of lymph node metastasis. This justifies a local excision of suspected deep submucosal invasive colon carcinomas (T1 CCs) as a first step treatment strategy. Recently Colonoscopy-Assisted Laparoscopic Wedge Resection (CAL-WR) has been shown to be able to resect pT1 CRCs with a high R0 resection rate, but the long term outcomes are lacking. The aim of this study is to evaluate the safety, effectiveness and long-term oncological outcomes of CAL-WR as primary treatment for patients with suspected superficial and also deeply-invasive T1 CCs.MethodsIn this prospective multicenter clinical trial, patients with a macroscopic and/or histologically suspected T1 CCs will receive CAL-WR as primary treatment in order to prevent unnecessary major surgery for low-risk T1 CCs. To make a CAL-WR technically feasible, the tumor may not include > 50% of the circumference and has to be localized at least 25 cm proximal from the anus. Also, there should be sufficient distance to the ileocecal valve to place a linear stapler. Before inclusion, all eligible patients will be assessed by an expert panel to confirm suspicion of T1 CC, estimate invasion depth and subsequent advise which local resection techniques are possible for removal of the lesion. The primary outcome of this study is the proportion of patients with pT1 CC that is curatively treated with CAL-WR only and in whom thus organ-preservation could be achieved. Secondary outcomes are 1) CAL-WR’s technical success and R0 resection rate for T1 CC, 2) procedure-related morbidity and mortality, 3) 5-year overall and disease free survival, 4) 3-year metastasis free survival, 5) procedure-related costs and 6) impact on quality of life. A sample size of 143 patients was calculated.DiscussionCAL-WR is a full-thickness local resection technique that could also be effective in removing pT1 colon cancer. With the lack of current endoscopic local resection techniques for > 15 mm pT1 CCs with deep submucosal invasion, CAL-WR could fill the gap between endoscopy and major oncologic surgery. The present study is the first to provide insight in the long-term oncological outcomes of CAL-WR.Trial registrationCCMO register (ToetsingOnline), NL81497.075.22, protocol version 2.3 (October 2022).

Schwannoma: A Rare Case of Submucosal Gastric Tumor.

Schwannoma is a tumor that originates from the Schwann cells that surround a neuron's axon. This tumor is very rare in the gastrointestinal tract and develops submucosally from intestinal nerve plexuses. The most common location for gastrointestinal schwannomas is the stomach, where they account for only 0.2% of gastric tumors. We present the case of a 56-year-old asymptomatic patient who was diagnosed, following a routine ultrasound examination, with an abdominal tumor. An abdominal MRI confirmed the gastric origin of the tumor. Although a subsequent upper-digestive endoscopic ultrasound was performed, a definitive diagnosis could not be established. Thus, a laparoscopic wedge resection of the stomach was performed. The immunohistochemical examination of the tumor established the diagnosis of benign schwannoma. Despite the availability of advanced endoscopy and imaging techniques, the diagnosis of gastric schwannoma is very rarely preoperative. The immunohistochemical identification of S-100 on the surgical specimen confirmed the diagnosis.

ASO Visual Abstract: Colonoscopy-Assisted Laparoscopic Wedge Resection for the Treatment of Suspected T1 Colon Cancer.

ASO Visual Abstract: Colonoscopy-Assisted Laparoscopic Wedge Resection for the Treatment of Suspected T1 Colon Cancer.

Laparoscopic Wedge Resection for Gastric Mesenchymal Tumor – Small Case Series

" Introduction: Gastric mesenchymal tumors are a pathology that is increasing in incidence in recent years but the treatment is not yet standardized. The laparoscopic approach to these lesions is a modern option, with the patient benefiting from the advantages of minimally invasive surgery. Methods: We included in the study 4 patients operated laparoscopically for suspicion of gastric GISTs between Mars 2019 and May 2022. From a prospectively kept database, we extracted the following characteristics: age, sex, length of postoperative hospital admission, operation time, tumor location, tumor size, histopathological assessment of resection margins, intraoperative blood loss, and incidence of postoperative complications. Results: Average tumor size was 4.3 cm, ranging from 4 to 6 cm. Laparoscopic wedge resection was possible in all cases. There was no conversion, no episode of tumor rupture or spillage, and no major intraoperative complications. Histology confirmed a GIST in 3 of 4 cases. In one case histological workup showed gastric schwannoma. Conclusion: Laparoscopic wedge resection for gastric stromal tumors, even larger than 5 cm, appears to be safe and feasible in selected patients, with acceptable operative time and oncological outcome after an intermediate follow-up. More important than the size of tumors that are approached laparoscopically is their location and the possibility of a stenosis-free resection."

ASO Author Reflections: Colonoscopic-Assisted Laparoscopic Wedge Resection Seems a Valuable Addition to the Current Local Resection Techniques in Case of Suspected Deep-Invasive T1 Colon Cancer.

ASO Author Reflections: Colonoscopic-Assisted Laparoscopic Wedge Resection Seems a Valuable Addition to the Current Local Resection Techniques in Case of Suspected Deep-Invasive T1 Colon Cancer.

Colonoscopy-Assisted Laparoscopic Wedge Resection for the Treatment of Suspected T1 Colon Cancer.

Local en bloc resection of pT1 colon cancer has been gaining acceptance during the last few years. In the absence of histological risk factors, the risk of lymph-node metastases (LNM) is negligible and does not outweigh the morbidity and mortality of an oncologic resection. Colonoscopy-assisted laparoscopic wedge resection (CAL-WR) has proved to be an effective and safe technique for removing complex benign polyps. The role of CAL-WR for the primary resection of suspected T1 colon cancer has to be established. This retrospective study aimed to determine the radicality and safety of CAL-WR as a local en bloc resection technique for a suspected T1 colon cancer. Therefore, the study identified patients in whom high-grade dysplasia or a T1 colon carcinoma was suspected based on histology and/or macroscopic assessment, requiring an en bloc resection. The study analyzed 57 patients who underwent CAL-WR for a suspected macroscopic polyp or polyps with biopsy-proven high-grade dysplasia or T1 colon carcinoma. For 27 of these 57 patients, a pT1 colon carcinoma was diagnosed at pathologic examination after CAL-WR. Histological risk factors for LNM were present in three cases, and 70% showed deep submucosal invasion (Sm2/Sm3). For patients with pT1 colon carcinoma, an overall R0-resection rate of 88.9% was achieved. A minor complication was noted in one patient (1.8%). The CAL-WR procedure is an effective and safe technique for suspected high-grade dysplasia or T1-colon carcinoma. It may fill the gap for tumors that are macroscopic suspected for deep submucosal invasion, providing more patients an organ-preserving treatment option.

Laparoscopic Wedge Resection of a Cesarean Scar Ectopic Pregnancy at Nine Weeks Gestation

<h3>Study Objective</h3> To demonstrate an approach to laparoscopic wedge resection of a cesarean scar pregnancy (CSP). <h3>Design</h3> Video abstract. <h3>Setting</h3> Tertiary care Centre. <h3>Patients or Participants</h3> This case is of a 40-year-old G6P3, with 3 prior cesarean sections who was referred with a possible ectopic pregnancy at 8+3 weeks gestation after presenting with cramping and irregular bleeding. Following admission to hospital, transvaginal ultrasound revealed a CSP and a type 1 placenta percreta with no bladder involvement. The patient wished for fertility-sparing management which was planned to include pre-operative intragestational methotrexate and uterine artery embolization followed by laparoscopic wedge resection. Before pre-operative interventions could be done, the patient experienced acute vaginal bleeding and she was taken urgently for surgical management. <h3>Interventions</h3> Laparoscopic wedge resection of the CSP. <h3>Measurements and Main Results</h3> Laparoscopy revealed bladder adhesions high over the lower uterine segment and the CSP. Wedge resection of the CSP was successfully achieved with restoration of normal anatomy using a systematic approach to lysis of adhesions as well as intraoperative vascular control using dilute vasopressin and pre-emptive skeletonization of the uterine vessels. Surgical blood loss was 100mL. There were no intraoperative or postoperative complications, and the patient was discharged home post-operative day 1. The patient's beta HCG levels returned to normal within one month. <h3>Conclusion</h3> CSPs account for approximately 4% of all ectopic pregnancies. Management is individualized and often requires a multi-modal approach. This case demonstrates a safe and successful approach to fertility-sparing laparoscopic wedge resection.

Surgical Management of Second Trimester Cesarean Scar Ectopic Pregnancy with Laparoscopic Wedge Resection

<h3>Study Objective</h3> To review the case of a second trimester cesarean scar ectopic pregnancy managed with laparoscopic resection in a patient with a history of renal transplant. <h3>Design</h3> Video demonstration of surgical technique with narrated description. <h3>Setting</h3> Academic tertiary care site. <h3>Patients or Participants</h3> 36yo G5P0221 found to have a 14-week cesarean scar ectopic pregnancy, desiring fertility sparing intervention. <h3>Interventions</h3> In this video, we demonstrate the case of a second trimester cesarean scar ectopic pregnancy resected laparoscopically. We illustrate several key points including: - Safe port placement in the setting of prior renal transplant - Preemptive hemostasis management with temporary uterine artery ligation - Intraoperative strategies for reducing blood loss - Considerations for management of gestational sac rupture and abdominal spill of fetal contents <h3>Measurements and Main Results</h3> A 14-week cesarean scar ectopic pregnancy was successfully resected with minimal blood loss and excellent recovery. <h3>Conclusion</h3> Laparoscopic resection can be safely and effectively utilized even for cesarean scar ectopic pregnancies of more advanced gestational ages.

Trocar layouts in laparoscopic liver surgery.

Since the first laparoscopic wedge resection reported by Reich, laparoscopic liver resection (LLR) has been progressively developed, acquiring safety and feasibility. The time has witnessed a milestone leap for laparoscopic hepatectomy from pure laparoscopic partial hepatectomy to anatomical hepatectomy and from minor liver resection to major liver resection. The numerous previous studies have paid more attention to the short-time and long-time surgical outcomes caused by surgical techniques corresponding to various segments and approaches. However, focus on trocar layouts remains poorly described, but it plays an indispensable role in surgical process. We have searched PubMed for English language articles with the key words "trocar," "laparoscopic liver resection," and "liver resection approaches." This review highlighted each type of trocar layouts corresponding to specific circumstances, including targeted resection segments with various approaches. Notably, surgeon preferences and patients body habitus affect the trocar layouts to some extent as well. Although there were fewer researches focus on trocar layouts, they determine the operation field and manipulation space and be likely to have an impact on outcomes of surgery. Therefore, further studies are warranted to firm the role of trocar layouts in LLR.

Combined endoscopic and laparoscopic surgery for the treatment of complex benign colonic polyps (CELS): Observational study

PurposeCombined endoscopic and laparoscopic surgery (CELS) has emerged as a promising method for managing complex benign lesions that would otherwise require major colonic resection. The aim of this study was to describe the different techniques and to evaluate the safety of CELS, assess its outcomes in a technique that is scarcely widespread in our environment. MethodObservational retrospective study, short-term outcomes of patients undergoing CELS for benign colon polyps from October 2018 to June 2020 were evaluated. Postoperative outcomes, length of hospital stay and pathological findings were evaluated. ResultsSeventeen consecutive patients underwent CELS during the study period. The median size of the lesion was 3.5 cm (range 2.5–6.5 cm), the most frequent location was the cecum (10 from 17). Most patients treated with CELS underwent an endoscopic-assisted laparoscopic wedge resection (11 from 17). In four patients this resection was combined with another CELS technique, and two patients underwent an endoscopic-assisted laparoscopic segment resection. The success rate of CELS in our series was in 14 from 17 (82.4%). The median operative time was 85 min (range 50−225 min). The median hospital stay was 2 days (range 1–15 days). One patient experienced an organ/space surgical site infection which did not require further intervention. Four lesions were shown to be malignant by postoperative pathology study. ConclusionCELS is a safe and multidisciplinar technique that requires collaboration between gastroenterologists and surgeons. It can be considered as an alternative to colonic resection for complex benign colonic polyps.

Robotic excision of gastric and duodenal gastrointestinal stromal tumor.

Gastrointestinal stromal tumors (GIST) originate from interstitial cells of Cajal and are most often located in the stomach. The mainstay of treatment for GIST is surgical resection. Laparoscopic wedge resection of gastric GIST using linear staplers has been commonly performed and shown to be feasible and safe. However, this technique is not suitable for tumors at particular anatomical locations such as the gastric cardia near the gastroesophageal junction, the lesser curvature of stomach, and the duodenum. The robotic surgery platform with augmented surgical skills has enabled precise dissection and suturing. We consider robotic GIST excision with primary suture closure to be useful for lesions in the above-mentioned locations. In this video, we demonstrate our techniques of robotic excision of gastric and duodenal GIST. At our institution, 13 patients underwent robotic excision of gastric and duodenal GIST between November 2018 and July 2021. Tumor locations included the cardia (n = 2), gastric body (n = 10) [lesser curvature (n = 3) and other (n = 7)], and the duodenum (n = 1). There were no conversions to open laparotomy. The median operation time was 160min (range 80-270), and median blood loss was 25mL (range 5-50). The median length of hospital stay was 3days (range 1-4). There were no complications or readmissions within 90days. We demonstrated the feasibility and safety of robotic resection of GIST located at the stomach and duodenum. Especially in anatomically challenging locations where the stapling technique is not suitable, robotic approaches are considered useful for performing precise excision.

Single Surgical Approach for Gastric Gastrointestinal Stromal Tumor and Cholecystolitiasis by Laparoscopic Procedure

Introduction: Gastrointestinal stromal tumor (GIST) is a rare neoplasm representing 80% of gastrointestinal neoplasms. Laparoscopic resection is only recommended for GIST less than 2 cm and 5 cm for laparoscopic wedge resection. Thus, a large GIST is recommended to complete resection through laparotomy. A large GIST of the gastric fundus can be found in patients, which coincides with an upper right abdominal quadrant pain caused by cholecystolithiasis. A suggested laparotomy for tumor resection and cholecystectomy may result in poor recovery in the postoperative period. Therefore, one approach surgery with minimally invasive laparoscopic partial gastrectomy using Endoflex stapler and cholecystectomy was performed to achieve the optimal outcome.Case Presentation: A 43-year-old male had a major complaint of hematemesis and melena for one month and colicky pain in the right upper quadrant of the abdomen with increased intensity in the last two months. Contrast-enhanced abdominal MSCT revealed a solid 4.6 x 4 x 5.6 cm exophytic mass on the gastric fundus, added with 0.5 cm gall bladder stone. Laparoscopic partial gastrectomy and cholecystectomy were performed in a single minimal invasive surgical procedure. The post-operative period was uneventful. The patient experienced minimum pain, early mobilization, and better diet tolerance. He was discharged on day four after the surgery. Besides, the histopathologic result revealed a malignant mesenchymal tumor according to GIST with a tumor-free margin of resection.Conclusions: Single approach surgery with minimal laparoscopic partial gastrectomy and cholecystectomy has provided optimal outcomes for patients with large GIST and cholecystolithiasis.

Complete laparoscopic wedge resection of a giant locally advanced gastric GIST with near pathological complete response after preoperative treatment with imatinib mesylate: A case report.

Introduction and importanceSurgical resection is the only curative treatment for gastrointestinal stromal tumor (GIST). Laparoscopic approach for large (>5 cm) and giant (>10 cm) gastric GIST remains under controversy. What's more, whether laparoscopic surgery could be performed after preoperative imatinib treatment of giant gastric GIST is still unknown.Case presentationWe report a 68-year-old man with a giant (almost 30 cm) locally advanced gastric GIST which required resection of contiguous organs initially. After received 12 months imatinib therapy, the tumor became resectable and he finally achieved a complete laparoscopic wedge resection. Pathological evaluation of the resected specimen revealed a near pathological complete response was obtained. The imatinib treatment was ongoing after surgical resection and there was no radiological or clinical evidence of disease recurrence until to October 2021.Clinical discussionLaparoscopic approach is safe and effective for gastric GIST. Even for lesions greater for 5 cm. However, there are few reports for the application of laparoscopic wedge resection for gastric GIST larger than 10 cm. Preoperative use of imatinib can decrease the tumor size, so that may increase the chance of laparoscopic approach.ConclusionPreoperative imatinib therapy was effective for reducing the gastric GIST, which may increase the chance of minimally invasive approach and organ preservation. Patients with locally advanced GIST could benefit from the multidisciplinary approach.