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Minimally Invasive Options for Gastrointestinal Stromal Tumors of the Stomach

Laura Mazer, MD, Patrick Worth, MD, Brendan Visser, MD, FACS. Stanford University

INTRODUCTION: Gastrointestinal stromal tumors (GIST) are rare mesenchymal tumors, most commonly in the stomach. Surgical resection remains the mainstay of cure. Selecting a resection approach depends on tumor size and location.

METHODS: Retrospective review of all patients undergoing surgery at one academic center between 2000-2018. Comparisons and descriptive statistics using chi square and student’s t test.

RESULTS: 77 patients underwent resection, 69% laparoscopic. Patients undergoing open operations had significantly larger tumors (8.1 vs 4.3 cm, p = <0.001) Operative time was not significantly longer for laparoscopic resection, (122 vs 105 minutes, p 0.264), length of stay was significantly shorter (4 vs 7 days, p <0.001). Complication rate was higher in open operations (41% vs 17%, p <0.001). There were four types of resection:  stapled wedge resection, resection of a full thickness ‘disk’ of stomach around the tumor with a primary closure, partial gastrectomy with reconstruction, and laparoscopic trans-gastric (endoluminal) resection.

  Stapled wedge (n=47) Disk resection (n=9) Partial gastrectomy (n=16) Endoluminal excision (n=5)
Laparoscopic (%) 79 67 31 100
Tumor size (mean, cm) 4.8 5.8 7.7 4.2

Location (%)  Cardia

Lesser curve

Body

Greater curve

Antrum

 

33

25

17

21

4

 

22

33

22

11

11

 

6

13

31

19

31

 

100

0

0

0

0

Tumor spillage (n) 2 (4%) 0 (0%) 1 (6%) 0 (0%)
Endoscopy (%) 28 11 0 100
Operative time (mean, min) 101 142 146 175
Length of stay 3.7 5 7.4 3.6

CONCLUSIONS: Wedge resection is most feasible for tumors on the greater curve or body, far enough from the pylorus and gastroesophageal junction to avoid narrowing inflow or outflow. A partial gastrectomy is sometimes required for large tumors or those close to the esophagus or pylorus. For small intraluminal tumors, a laparoscopic transgastric approach is ideal. A review of the technical details of each resection can aid in operative planning for difficult tumors.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 94862

Program Number: P498

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

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