Various methods of laparoscopic resection of gastric submucosal tumor accoding to location and growth pattern

Ji Hoon Jo, MD, Young Il Choi, MD, Ji Young Yoo, MD, Seung Hoon Lee, MD, Sang Hong Choi, MD, Ki Young Yoon, Kyung Won Seo, MD, Song I Yang, MD. Kosin University College of Medicine

Background:Laparoscopic resection of gastric SMT near Esophagogastric junction(EGJ) or pylorus is a demanding surgical technique. This study aimed to assess various methods of laparoscopic resection could be applied according to the location and the growth pattern of the gastric SMT.

Methods:Between March 2012 and June 2014, 29 patients with gastric SMT who underwent laparoscopic resection were included. The patients’ demographics, clinicopathologic and perioperative data were reviewed.

Results:Among 29 patients had attempted laparoscopic approach, open conversions were 2 cases. Conventional wedge resection including eversion technique was performed in 14 cases, single port intragastric resection in 8, laparoscopic-endoscopic collaborating surgery in 3, each one case of stomach segmental resection, distal gastrectomy, total gastrectomy and wedge resection with prophylactic antireflux surgery. Postoperative complications were reported in 2 cases. ( staple line bleeing in 1 and delayed gastric emptying in 1) Gastrointestinal stromal tumors were 21 cases (72.4%), and benign spindle cell tumor were 3 cases. For tumors located within 5 cm to EGJ or pylorus, more nonconventional resection methods were observed. (p=0.009) And more endophytic tumor growth was observed in this group. (p=0.000)

Conclusion:Various methods of laparoscopic resection would be necessary for variously located gastric submucosal tumor. Especially for tumors located near to EGJ or pylorus and to be endophytic growth, various methods are needed to avoid aggressive resection.

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