J Gastric Cancer.  2010 Dec;10(4):188-195.

Image-based Approach for Surgical Resection of Gastric Submucosal Tumors

• Kim YM
• Lim JS
• Kim JH
• Hyung WJ
• Noh SH

Abstract

PURPOSE
This study was done to evaluate the usefulness of preoperative computed tomography (CT) and intraoperative laparoscopic ultrasound to facilitate treatment of gastric submucosal tumors.
MATERIALS AND METHODS
The feasibility of laparoscopic wedge resection as determined by CT findings of tumor size, location, and growth pattern was correlated with surgical findings in 89 consecutive operations. The role of laparoscopic ultrasound for tumor localization was analyzed.
RESULTS
Twenty-three patients were considered unsuitable for laparoscopic wedge resection because of large tumor size (N=13) or involvement of the gastroesophageal junction (N=9) or pyloric channel (N=1). Laparoscopic wedge resection was not attempted in 11 of these patients because of large tumor size. Laparoscopic wedge resection was successfully performed in 65 of 66 (98.5%) patients considered suitable for this procedure. Incorrect interpretation of preoperative CT resulted in a change of surgery type in seven patients (7.9%): incorrect CT diagnosis on gastroesophageal junction involvement (N=6) and on growth pattern (N=1). In 18 patients without an exophytic growth pattern, laparoscopic ultrasound was necessary and successfully localized all lesions.
CONCLUSIONS
Preoperative CT and laparoscopic ultrasound are useful for surgical planning and tumor localization in laparoscopic wedge resection.

Keyword

Computed tomography; Gastric submucosal tumor; Laparoscopic ultrasound; Laparoscopic wedge resection; Minimal invasive surgery

MeSH Terms

Esophagogastric Junction
Humans

Figure

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  Fig. 1 Image-based approach for laparoscopic wedge resection. SMT = submucosal tumor; LUS = laparoscopic ultrasound.

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  Fig. 2 Estimation of the involvement of the gastric extremities. (A) A 49-year-old woman with pathologically confirmed true leiomyoma. Gastroesophageal junction involvement was found (arrow). Thus, this patient underwent laparoscopic total gastrectomy. (B) A 69-year-old man with pathologically confirmed gastrointestinal stromal tumor. This patient underwent laparoscopic subtotal gastrectomy due to pyloric channel involvement of the tumor (white and black arrows). (C) A 46-year-old woman with pathologically confirmed gastrointestinal stromal tumor (long arrow) in the gastric upper body. The distance between the gastroesophageal junction and the proximal tumor margin was measured as 2.1 cm (short arrow). This patient was regarded as acceptable for laparoscopic wedge resection and underwent the surgery.

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  Fig. 3 Use of laparoscopic ultrasound for laparoscopic localization. (A) CT imaging demonstrated a 1.5-cm intraluminal lesion without exophytic component in gastric fundus (arrow). (B) The lesion was not detected by laparoscope. LUS probe were searching for the lesion. (C) It was easily detected by laparoscopic ultrasound (arrow). (D) Gastrotomy was performed with a dissector at the site localized by laparoscopic ultrasound. The gastrotomy site accurately coincided with the lesion (arrow). The lesion was easily resected. CT = computer tomography; LUS = laparoscopic ultrasound.

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  Fig. 4 Intraoperative results of 23 patients deemed not suitable for laparoscopic wedge resection based on preoperative CT findings. CT = computed tomography.

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  Fig. 5 Intraoperative results of 66 patients deemed suitable for laparoscopic wedge resection based on preoperative CT findings. CT = computed tomography; LUS = laparoscopic ultrasound.

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