Long-term outcomes of laparoscopic resection of gastric gastrointestinal stromal tumors.

Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1000 Blythe Boulevard, Charlotte, NC 28203, USA.
Annals of Surgery (Impact Factor: 7.19). 07/2006; 243(6):738-45; discussion 745-7. DOI: 10.1097/01.sla.0000219739.11758.27
Source: PubMed

ABSTRACT Gastric gastrointestinal stromal tumors (GISTs) are rare neoplasms that require excision for cure. Although the feasibility of minimally invasive resection of gastric GIST has been established, the long-term safety and efficacy of these techniques are unclear. We hypothesized that complete resection of gastric GISTs using a combination of laparoscopic or laparoendoscopic techniques results in low perioperative morbidity and an effective long-term control of the disease.
Between August 1996 and June 2005, 50 consecutive patients undergoing laparoscopic or laparoendoscopic resection of gastric GISTs were identified in a prospectively collected database. Outcome measures included patient demographics and outcomes, operative findings, morbidity, and histopathologic characteristics of the tumor. Patient and tumor characteristics were analyzed to identify risk factors for tumor recurrence.
Fifty patients, mean age 60 years (range, 34-84 years), underwent 47 local and 3 segmental laparoscopic gastric resections. GI bleeding and dyspepsia were the most common symptoms. Mean tumor size was 4.4 cm (range, 1.0-8.5 cm) with the majority of the lesions located in the proximal stomach. Mean operative time was 135 minutes (range, 49-295 minutes), the mean blood loss was 85 mL (range, 10-450 mL), and the mean length of hospitalization was 3.8 days (range 1-10 days). There were no major perioperative complications or mortalities. All lesions had negative resection margins (range, 2-45 mm). Nine patients had 10 or more mitotic figures per 50 high power fields, while 11 had ulceration and/or necrosis of the lesion. At a mean follow-up of 36 months, 46 (92%) patients were disease free, 1 patient was alive with disease, 1 patient with metastases died of a cardiac event, and 2 (4%) patients died of metastatic disease. No local or port site recurrences have been identified. Patient age, tumor size, mitotic index, tumor ulceration, and necrosis were statistically associated with tumor recurrence. The presence of 10 or more mitotic figures per 50 high power fields was an independent predictor of disease progression (P = 0.006).
A laparoscopic approach to surgical resection of gastric GIST is associated with low morbidity and short hospitalization. As found in historical series of open operative resection, the tumor mitotic index predicts local recurrence. The long-term disease-free survival of 92% in our study establishes laparoscopic resection as safe and effective in treating gastric GISTs. Given these findings as well as the advantages afforded by minimally invasive surgery, a laparoscopic approach may be the preferred resection technique in most patients with small- and medium-sized gastric GISTs.

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    ABSTRACT: Aim of the study: Gastrointestinal stromal tumors (GISTs) may now be considered to encompass mesenchymal tumors that express Kit protein (CD117) or have activating mutations of receptor tyrosine kinase genes (PDGFRA). The purpose of this study is to define clinicopathologic characteristics of gastric GISTs in children. Materials and Methods: We conducted a review of the literature from 1962 and enrolled 85 patients (younger than 16 years of age) with gastric GISTs, including two cases treated in our pediatric surgery unit. All the patients’ clinical data and followup information were reviewed, including age, gender, tumour size and localization, presence of Kit mutation and outcome. Case 1: A 16-year-old girl with a history of weakness and pallor. A computer tomography scan confirmed 4 gastric lesions. The lesion in the fundus was excised and an inferior-middle gastric resection was perfomed. At 3 years follow-up the patient presents a progression of liver metastasis. Case 2: A 13-year-old boy was referred to our pediatric surgery unit because of an ulcerated neoformation of 3-cm-sized located in the gastric antrum. The patient underwent laparotomy gastric wedge resection. At the follow-up of 9 years the patient was disease free. Results: Our results are based on our systematic review of 85 cases. The multifocal disease was identified in 21 children (25%). 10 patients are died, all patients presented liver metastases but only 1 had multiple nodules. Conclusions: The majority of GISTs occur in girls that suggests a developmentally related sex difference. There are no relationship between multiple locations and worst prognosis. The presence of liver metastases is associated with a shorter survival.
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    ABSTRACT: Gastrointestinal stromal tumors (GIST) are rare tumors of the digestive tract, with an incidence of about 1.5 per 100,000/year. Clinical features may vary depending on location, size and aggressiveness. The diagnosis is confirmed by immunohistochemistry tests that identify CD 117 or DOG1 (typical receptors/markers for most GISTs) at the level of biopsy specimen. The treatment of localized GIST is based primarily on the surgery, while for metastatic GIST the targeted therapy with tyrosine kinase inhibitors represents the current standard. The neoadjuvant and adjuvant therapy indications guided and depending on genetic analysis included in the diagnostic and treatment algorithm as well as the strategy for cases surveillance are listed in the journal. All these data obtained from the literature have been integrated in a practical experience of 19 cases of GIST, operated in the clinic in the last 10 years for which we have proposed an adapted diagnostic algorithm.
    Journal of medicine and life 06/2014; 7(2):139-149.
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    ABSTRACT: Laparoscopic gastric wedge resection is a standard treatment for removing gastric submucosal tumors (SMTs). So far, however, there have been few reports of single-incision laparoscopic intragastric wedge resection. Our aim was to describe this procedure and our experience with it. From January 2010 to December 2013, a total of 21 consecutive patients with gastric SMTs underwent single-incision intragastric resection at our institution. Their clinicopathologic data were analyzed retrospectively. The patients consisted of nine men and 12 women with a mean age of 51.9 ± 12.9 years (22-69 years). Their mean body mass index was 22.6 ± 2.0 kg/m(2). Mean tumor size was 2.4 ± 0.7 cm, with the following anatomic distribution: esophagogastric junction in three patients, fundus in twelve, upper body in three, and lower body in two. Mean operating time was 68.6 ± 12.0 minutes. There were no conversions to open surgery and no major intraoperative complications. Time to resumption of water intake was 1.4 ± 0.5 days. Mean hospital stay was 4.9 ± 1.7 days. There were no recurrences or deaths during the mean 19-month follow-up. Single-incision intragastric wedge resection is a feasible and safe procedure. It is especially efficient for treating small endophytic gastric SMTs located on the upper and mid portion of the stomach.
    Annals of surgical treatment and research. 12/2014; 87(6):304-310.


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