Cardia-preserving Combined Endoscopic/Laparoscopic Intragastric Resection of Proximal Gastric Submucosal Tumors

Xianlin Han, MD, Weiming Kang, MD, Zhiqiang Ma, MD, Xin Ye, MD, Jianchun Yu, MD. Peking Union Medical College Hospital

Introduction: This study evaluated the feasibility, security and surgical outcome of the combined endoscopic/laparoscopic intragastric resection of gastric tumors through anterior incisional mode. The gastric submucosal masses includes benign tumors (eg, lipoma and leiomyoma) and potentially malignant tumors (eg, Gastric stromal tumor). It will increase the difficulties and risks of the procedure, if the tumor is located in the posterior wall of proximal stomach body and fundus. This modified operation mode can maximally fulfill the potential of preservation of cardia, which means much better quality of life and much better prognosis to patients with proximal submucosal gastric tumors.

Methods: 9 patients in total were admitted from February to July in early 2015. All the tumors, which ranges from 1.0cm×1.0cm to 6.0cm×6.0cm, were located proximally on the posterior wall of stomach body and fundus. All the operations were performed in the gastric lumen using laparoscopic instruments with gastroscope monitoring, and the tumors were all resected by intragastrically incising the anterior gastric wall.

Results: All the tumors were resected completely with cardia preservation, all with final pathology demonstration. The mean operation time was 168.5 minutes, with less than 150 ml blood loss and no peritoneotomy conversion. 1 patient was with postoperational seroperitoneum and pleural effusion, and treated well with CT guided interventional therapy. No postoperational complications happened in the other 8 patients. All the patients were discharged in 3 to 9 days, with no postoperational evaluation of gastric motility and esophageal manometry. 6 patients with GIST had pathological demonstration, which the immunehistochemical staining were 100% positive for CD34 and 83% positive for CD117. For 3 leiomyoma tumors, all were positive for SMA.

Conclusions: The combined endoscopic/laparoscopic gastric fundus tumor intragastric resection highly proved to be feasible, safe and effective treatments for proximal gastric submucosal patients. All the patients have complete or partial cardia preservation, which indicates better patient prognosis and higher life quality.

Key word: Cardia-preserving; Laparoscpy; Endoscopy;Submucosal tumor

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