Robot-Assisted Partial Gastrectomy for the Treatment of Gastro-Intestinal Stromal Tumors

Jack W Rostas, MD, Tiffany H Patterson, BS, Russell E Brown, MD, Lee W Thompson, MD

Department of General Surgery, University of South Alabama, Mobile, AL; Cancer Surgery of Mobile, Mobile Infirmary Medical Center, Mobile, AL

The treatment of primary gastro-intestinal stromal tumors (GISTs) of the stomach is resection with microscopically negative margins (R0 resection). With the effectiveness of tyrosine kinase inhibitors in the treatment of GISTs, the method of resection must come with little expected morbidity. This applies to patients with primary lesions >2cm readily amenable to removal, or with small (<2cm) lesions harboring high risk features. Robotic-assisted resection provides all the advantages of a minimally invasive approach, with the additional benefit of improved visualization and more versatile instrumentation. This study was undertaken to review the characteristics, safety, and outcomes of robotic-assisted procedures for the resection of gastric GISTs.

A retrospective review was conducted from December 2010 to August 2012 of all patients deemed candidates for primary resection of GISTs. All patients underwent pre-operative endoscopic ultrasound with biopsy. Procedures were performed via robot-assisted laparoscopy (da Vinci Surgical System, Intuitive Surgical Inc., Sunnyvale, CA).

Ten patients underwent robotic-assisted partial gastrectomy. Four lesions (40%) were located near the gastro-esophageal junction. The average age of the group was 64.7 (34 – 77) years and BMI was 31.2 (23.7 – 46.8) kg/m2. Average tumor size was 3.8 (1.1 – 7.3) cm and length of stay was 5.1 (1-9) days. All patients had a complete (R0) resection on final pathological analysis. Three lesions (30%) were intermediate or high risk per Fletcher criteria. Mortality was 0% and one patient experienced significant post-operative morbidity (edema at suture line of gastric resection, necessitating a delay in diet advancement). There have been no tumor recurrences.

Robot assisted resection of gastric GISTs is a safe and effective procedure, and may make lesions in difficult locations amenable to resection by minimally invasive techniques. Randomized trials are needed to ascertain the full potential benefit of this modality.

Session: Poster Presentation

Program Number: P648

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