Andrés Navarrete, MD1, Dulce Momblan, MD2, Marta Jimenez-Toscano, MD2, Ricard Corcelles, MD2, Ainitze Ibarzabal, MD2, Antonio Lacy2. 1Clinica Alemana of Santiago, 2Hospital Clinic of Barcelona
Background: Gastrointestinal Stromal Tumors (GIST) are the most frequent mesenchymal gastrointestinal tumors and represents the 0.1–3% of all gastrointestinal malignancy. The management of GISTs is based on surgical resection, because it is the only therapy that has showed to be potentially curative. Fortunately, this tumors show low lymphatic node involvement. That is why, in many GISTs lesions, optimal oncological resection can be achieve making wedge resections. Laparoscopic surgery for gastrointestinal stromal tumors has been evolving rapidly over the past decade. The aim of this study is to describe our experience in terms of feasibility and safety of laparoscopic resection of gastric GISTs independently to tumor size and its effect on oncologic outcome in an elderly population.
Materials and Methods: A retrospective analysis was performed from a prospective collected database at a tertiary hospital from January 2002 to May 2016.
Results: A total of 23 patients > 60 years old underwent laparoscopic wedge resections for gastric GIST. The mean age was 70.6±9 years-old with a mean BMI of 26.5±4 kg/m2. Symptomatic presentation was observed in 60.1% of the cases.The most common symptom was epigastric pain 34.7% and bleeding as; anemia in 17.3%%, melena and hematemesis in 4.3% each one. GIST was located in the upper third of the stomach in 6 cases, 14 in the middle third and 3 cases in the lower third. The mean size of the tumors was 5.5± cm (range 3.0-16.0 cm). Neoadjuvant therapy was indicated in 4 cases, all of them with tumor size >10 cm. In this group the size changed from 12.2± 3.8 cm to 4.4±1.7 cm, achieving a 63.9% tumor size reduction. All cases were done laparoscopically without tumor rupture and no conversion. The mean operative time was 90.6± 38 minutes. No intraoperative complication neither 90-days mortality was observed. Negative resection margins was achieved in 100% of cases. The mean follow-up was 36.7 months (range 5-84). We had 1 case (4.3%) of early postoperative complication with a stenosis that needed a subtotal gastrectomy performed by laparoscopy. No recurrence was identified during follow-up. The tumor-related survival during follow-up was 100%.
Conclusion: Laparoscopic wedge resection for gastric GISTs is feasible, safe, and effective on long-term oncological outcome for elderly patients. The use of neoadjuvant therapy can help to achieve organ-sparing resections.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77339
Program Number: P406
Presentation Session: Poster (Non CME)
Presentation Type: Poster