Exploration of different single incision laparoscopic operations for the resection of gastric stromal tumors

Kong Jing, MD, Wu Shuo-dong. Shengjing Hospital of China Medical University

INTRODUCTION: GISTs are potentially malignant tumors and clinical practice guidelines for GISTs recommend surgical resection if it can be completely resected.In recent years, transumbilical single-incision laparoscopic surgery (SILS) partial gastrectomy, although still in its initial stages, has been performed increasingly often for resection of small GISTs because of its cosmetic advantage. However, the tumors larger or the tumors located at the cardia or pylorus, proximal or distal gastrectomy, rather than partial gastrectomy was considered needed. The authors reported the new technique of umbilical single-incision laparoscopic surgery (SILS) and explored the different operations in the treatment of gastrointestinal stromal tumors (GISTs) of the stomach with conventional laparoscopic instruments.

METHODS: Data of 34 gastric GISTs who had SILS treatment were analyzed retrospectively at Shengjing Hospital of China Medical University between December 2009 and February 2014.

Demographic data, operative details, recovery parameters, and details of the specimen were obtained and analyzed based on the information obtained from the medical records. The location of tumor was evaluated by preoperative CT and EUS, also it was confirmed during the operation. Tumor size, grade and malignant risk were evaluated by pathology.

RESULTS: SILS partial gastrectomy was performed in 27 patients, the mean size of the tumors was 2.6 cm (0.6-6.5 cm), the mean operating time was 95 min, the average blood loss was 47 ml.

SILS distal gastrectomy was performed in 4 cases with the tumor located near pylorus and larger than 2cm. Also distal gastrectomy was performed in 2 patients with tumor 8.5 and 10cm respectively. Among these 6 patients, 5 cases used BII Gastric jejunum anastomosis and 1 case gastric-duodenal triangular anastomosis. The mean size of the tumors was 6.6 cm (3.5-10 cm), the mean operating time was 240 min, the average blood loss was 216 ml.

Subtotal gastrectomy and combined organ resection in 1 cases.

There were no intraoperative or postoperative complications experienced in all the patients except one postoperative intraperitoneal bleeding and one incision infection.

CONCLUSION: SILS for GISTs is a feasible and safe technique when performed by experienced laparoscopic surgeons. Suitable SILS operations should be selected for GISTs according their different size and location.

Key Words: Gastric stromal tumor; Laparoscopic; SILS; Partial gastrectomy; Subtotal gastrectomy

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