Seda Dzhantukhanova, Yury Starkov, Mikhail Vybornyi. Vishnevsky Institute of Surgery
Background: Gastrointestinal stromal tumor (GIST) is the neoplasm with malignant potential, which have determined active surgical tactics requiring complete resection for cure.
Objective: To develop and demonstrate different surgical techniques for laparoscopic resection of gastric and duodenal GISTs in different clinical cases depending on the size and location of tumors.
Material and methods: In a period from 2005 to 2016, 72 patients underwent laparoscopic resection (67 – gastric resection, 5 – duodenal resection), using different techniques. All patients were investigated with upper GI endoscopy, EUS and abdominal contrast-CT, which allows us to get the complete evaluation of tumor, including size, location, type of growth and the GI layer. Based on the findings the decision on the type of resection was made.
The majority of resections were wedge or partial resections, performed using endoscopic steplers or using ultrasound scissors followed by double-suturing of gatro/duodenotomy.
In the cases of tumor location on the posterior gastric wall we mobilized the the greater curvature to get a direct approach to the tumor with extraluminal growth. In the cases with intraluminal growth we used transgastric approach with small 1,5 cm incision on the anterior gastric wall for endoscopic stepler.
Technically the most complex procedures were in the cases of tumor location close to anatomically narrow places and muscle sphincters (gastroesophageal junction, pylorus, duodenal bulb, duodenal flexure), with high risk of stenosis and dysfunction of anatomical sphincters. In such cases we used «lifting-technique» in which we dissect serous and muscle layers circumferentially around the tumor making partial enucleation of lesion followed by total resection preserving almost all normal tissue with minimal suturing and deformity at the site of surgery.
Results: Median operation time was 150 min. Recovery was uneventful and median post-op hospital stay was 5 + 2,4 (2-8) days. The pathology showed R0 resection in all cases. The mean follow-up period was 42 months (range 3-74 months) with no local or distant recurrence or stenosis at the site of surgery.
Conclusion: Laparoscopic resections for GISTs should be considered the treatment of choice for the patients with local disease, choosing the type of resection the most appropriate for individual patient.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87957
Program Number: P391
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster