J Gastric Cancer.  2011 Dec;11(4):239-242.

Totally Laparoscopic Resection for a Large Gastrointestinal Stromal Tumor of Stomach

• Lee JS
• Kim JJ
• Park SM

Abstract

A debate is currently ongoing about whether a large gastrointestinal stromal tumor (GIST) should be treated by the laparoscopic approach because of the increased risk of tumor rupture during manipulation of the tumor with laparoscopic instruments and the resultant peritoneal tumor dissemination. Herein, we report a case of a large GIST of the stomach which was successfully treated by the laparoscopic approach. A 57 year old female patient visited our institution complaining of postprandial epigastric discomfort. An esophagogastroduodenoscopy and an abdominal computed tomography scan revealed a 10x8 cm sized submucosal tumor at the greater curvature side of the gastric antrum. The patient underwent laparoscopic distal gastrectomy with intracorporeal Billroth-II reconstruction without any breakage of the tumor. Her postoperative course was uneventful and she was discharged on the 7th postoperative day. Even a large GIST of the stomach can safely be treated by the laparoscopic approach when it is performed with proper techniques by an experienced surgeon.

Keyword

Gastrointestinal stromal tumor; Stomach; Laparoscopy

MeSH Terms

Endoscopy, Digestive System
Female
Gastrectomy
Gastrointestinal Stromal Tumors
Humans
Laparoscopy
Pyloric Antrum
Rupture
Stomach

Figure

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  Fig. 1 An esophagogastroduodenoscopy finding of gastric gastrointestinal stromal tumor.

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  Fig. 2 Abdominal computed tomography findings of gastric gastrointestinal stromal tumor. A 10×8 cm sized homogeneously enhanced, well circumscribed mass which developed from the posterior wall of the gastric antrum was observed.

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  Fig. 3 An operative view of gastric gastrointestinal stromal tumor. After entering the lesser sac, a 10 cm sized huge mass was noted. There was no pancreatic invasion.

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  Fig. 4 Surgical wound. After resection, the specimen was placed into a plastic bag and retrieved through the umbilical port site which was extended to 4 cm length.

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  Fig. 5 Gross finding. Even though, the size of the mass was 10 cm, the mass was successfully resected and retrieved without any breakage.

Reference

1. Basu S, Balaji S, Bennett DH, Davies N. Gastrointestinal stromal tumors (GIST) and laparoscopic resection. Surg Endosc. 2007. 21:1685–1689.

2. Gervaz P, Huber O, Morel P. Surgical management of gastrointestinal stromal tumours. Br J Surg. 2009. 96:567–578.

3. Melstrom LG, Phillips JD, Bentrem DJ, Wayne JD. Laparoscopic versus open resection of gastric gastrointestinal stromal tumors. Am J Clin Oncol. 2011. [Epub ahead of print].

4. Ke CW, Cai JL, Chen DL, Zheng CZ. Extraluminal laparoscopic wedge resection of gastric submucosal tumors: a retrospective review of 84 cases. Surg Endosc. 2010. 24:1962–1968.

5. Goh BK, Chow PK, Chok AY, Chan WH, Chung YF, Ong HS, et al. Impact of the introduction of laparoscopic wedge resection as a surgical option for suspected small/medium-sized gastrointestinal stromal tumors of the stomach on perioperative and oncologic outcomes. World J Surg. 2010. 34:1847–1852.

6. Catena F, Di Battista M, Fusaroli P, Ansaloni L, Di Scioscio V, Santini D, et al. Laparoscopic treatment of gastric GIST: report of 21 cases and literature's review. J Gastrointest Surg. 2008. 12:561–568.

7. Novitsky YW, Kercher KW, Sing RF, Heniford BT. Long-term outcomes of laparoscopic resection of gastric gastrointestinal stromal tumors. Ann Surg. 2006. 243:738–745.

8. Ishikawa K, Inomata M, Etoh T, Shiromizu A, Shiraishi N, Arita T, et al. Long-term outcome of laparoscopic wedge resection for gastric submucosal tumor compared with open wedge resection. Surg Laparosc Endosc Percutan Tech. 2006. 16:82–85.

9. Demetri GD, Benjamin RS, Blanke CD, Blay JY, Casali P, Choi H, et al. NCCN Task Force. NCCN Task Force report: management of patients with gastrointestinal stromal tumor (GIST)--update of the NCCN clinical practice guidelines. J Natl Compr Canc Netw. 2007. 5:Suppl 2. S1–S29.