Endoscopic, Laparoscopic and Open Surgical Treatment Modalities of Gastric Gastrointestinal Stromal Tumors

Adem Akcakaya, Prof¹, Kemal Dolay, Prof¹, Mustafa Hasbahceci, MD¹, F.Betul Akcakaya, Ms², Ibrahim Aydogdu, MD². ¹Bezmialem Vakif University Medical Faculty Department of Surgery, ²Bezmialem Vakif University Medical Faculty

Introduction: The aim of the study was to evaluate the effect of tumor size and localization on choosing treatment modalities and also to compare the efficacy of endoscopic, laparoscopic and open surgical treatment of gastric gastrointestinal stromal tumors (GISTs). GISTs are rare and constitute only 1% of all malignant tumors of the GI tract while Gastric GISTs comprise only 1-3% of all malignant gastric tumors.

Methods and Procedures: We retrospectively reviewed all patients with a diagnosis of gastric GISTs. Between January 2008 and December 2014, 28 patients with gastric GIST who underwent laparoscopic wedge resection (Group 1, n=7), endoscopic enucleation (Group 2, n=5   ) and surgery (Group 3, n= 16) at Bezmialem Vakif University Medical Faculty Hospital and Sisli Training and Research Hospital were included.  

Results: There were 28 patients who have gastric GIST (17 male, 11female) with a mean age of 56.4±12 years (range   23-76). Mean tumor size was 65.9±48mm (range 22-200) for Group 1, 58.8±23 mm; for group 2, 26.8±4mm; for group 3, 81.25±56 mm. There were statistically significant differences between the groups according to the tumor size. Smaller the tumor size caused the chance of endoscopic enucleation to increase.  Location of tumors were   the fundus and cardia in 8 patients (28%), the corpus in 9 (32%), the antrum in 5 (17%), bi-zonal in 6 (21%). No cardia tumor was seen in laparoscopic wedge resection groups (Groups 2).   Total gastrectomy, subtotal gastrectomy and wedge-segmental resection were performed in 5, 5 and 6 patients, respectively (Groups 3). There were no major operative complications or mortalities. All lesions had negative margins. Endoscopic surveillance was accomplished in 26 patients (93 %) with no local or distant recurrences during follow up of each patient.

Conclusion: Tumor size of Gastric GISTs is the primary factor in choosing the resection method. Surgical modalities are secondarily associated with tumor localization. Endoscopic enucleation and laparoscopic wedge-segmental resections can be preferred in patients with small and medium sized gastric GISTs, respectively. Larger tumors necessitate subtotal or total gastrectomy