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