Laparoscopic Wedge Resection of Gastric Submucosal Tumors

Bac Nguyen Hoang, PhD MD, Long Vo Duy, MD. University Medical Center, Hochiminh city Viet Nam

Background Surgery remains the only curative treatment for gastrointestinal stromal tumor (GIST). Resection needs to ensure tumour-free margins while lymphadenectomy is not required. Thus, gastric wedge resection is the treatment of choice for small gastric tumors. Laparoscopic resection of gastric stromal tumors is being performed with increased frequency. The aim of this study is to evaluate the feasibility and safety of laparoscopic gastric wedge resection technique.
Methods This is a case series. Between July 2006 and June 2010, there were 15 patients with suspected gastric submucosal tumor undergoing laparoscopic wedge resection at University Medical Center, Hochiminh city, Vietnam. Patient demographics, clinical presentation, and imaging were analyzed. Perioperative parameters measured included operative time, estimated blood loss, intraoperative findings, surgical techniques, morbidity, and length of hospitalization. In addition, tumor histopathologic characteristics, including size, location were reviewed
Results All of the procedures were performed successfully by laparoscopy, with mean operative time of 55 ± 8.6 minutes. Mean tumor size was 4.4 cm (range, 1.0–10.5 cm) with the majority of the lesions (66.7%) located in the proximal stomach. All surgical margins were negative microscopically. The mean blood loss was 50 ± 12 ml and no patients was required reoperation. No lesions was missed. Histology confirmed GIST in 10 cases (of these, 2 cases were malignant GIST) and others 5 cases were benign neoplasms ( 2 cases of lipoma and others 3cases of leiomyoma). No patient had any evidence of staple-line anastomotic leak postoperatively. There were no major postoperative complications. 2 patients had minor complications (a trocar site cellulitis and a small fluid collection). No mortality was observed. The mean hospital stay was 4,2 days. The smallest surgical margins were 0.5 cm, with a mean distance of 1.4 ± 0.3 cm. Mean follow-up duration was 18 ± 4.3 months during which no recurrences or metastases were found.
Conclusion Laparoscopic wedge resection for gastric stromal tumor is feasible, safe, and effective. This approach is associated with low morbidity and short hospitalization. Given these findings as well as the advantages afforded by minimally invasive surgery, a laparoscopic approach may be the preferred resection technique in most patients with small- and medium-sized gastric GISTs.