The goal of surgical resection of gastric gastrointestinal stromal tumor (GIST) is to achieve a negative pathologic surgical margin while limiting morbidity. In most cases, nonanatomic wedge resections are sufficient. Laparoscopic surgery is an acceptable option as long as standard oncologic principles are followed, with multiple case series demonstrating similar oncological outcomes as open resection. Preoperative computed tomography (CT) scans, gastroscopy and endoscopic ultrasound allow for selection of a specific operative strategy based on tumor location, size and growth pattern. This video outlines a tailored approach for minimally invasive gastric GIST resection using five cases. The use of intraoperative endoscopy is highlighted as an adjunct, which helps in tumor localization, facilitates identification of tumor margins, and allows for verification of the integrity of the staple line post resection. In most cases, wedge resection is feasible. For GISTs with exophytic growth patterns, wedge resection may first require gastric mobilization. Transgastric resection is used for intraluminal posterior wall GISTs. Avoidance of direct tumor handling using stay sutures and endoloops is demonstrated. In conclusion, this video will demonstrate a selective approach and helpful hints for laparoscopic resection of gastric GIST.
Session: Podium Video Presentation
Program Number: V034