Laparoscopic Resection of Challenging Gastric Tumors

Noninvasive gastric tumors may have malignant potential and should be managed with resection. Large margins are not needed and many can be managed with laparoscopic wedge resection. Tumors along the fundus, anterior wall, and greater curvature of the stomach are approached relatively easily using endoscopic staplers. Tumors near the gastric cardia, lesser curvature and pylorus are a more difficult surgical problem. Stapled resection of proximal lesions risk compromising the gastroesophageal junction, and proximal or total gastrectomies with esophageal anastamoses have been considered. Distal lesion may require distal gastrectomy with gastrojejunal reconstruction. We present four cases of gastric tumors in such locations. In each case, we attempt to locally resect the tumors to free margins without removing excessive normal tissue. The first case involves a tumor at the gastric cardia managed by a creative stapling technique. The second case is a five cm tumor at the cardia managed by local resection with suture closure of the large resultant gastrotomy. The third case is a bulky tumor along the posterior, lesser curvature requiring full gastric mobilization and rotation to resect. The last case is a tumor near the pylorus managed without the need for distal gastrectomy. Using intraoperative endoscopy, creative stapling techniques, and laparoscopic suturing, these gastric tumors at challenging locations can be managed laparoscopically without the need for large resections.

Session: Podium Video Presentation

Program Number: V037

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