Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
권호 표지
DOI QR코드

DOI QR Code

Endoscopic and Laparoscopic Full-Thickness Resection of Endophytic Gastric Submucosal Tumors Very Close to the Esophagogastric Junction

  • Kwon, Oh Kyoung (Gastric Cancer Center, Kyungpook National University Medical Center) ;
  • Yu, Wansik (Gastric Cancer Center, Kyungpook National University Medical Center)
  • Received : 2015.11.26
  • Accepted : 2015.12.09
  • Published : 2015.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Gastric submucosal tumors (SMTs) located very close to the esophagogastric junction (EGJ) are a challenge for gastric surgeons. Therefore, this study reports on the experience of using endoscopic and laparoscopic full-thickness resection (ELFR) with laparoscopic two-layer suturing in such tumors. Materials and Methods: Six patients with gastric SMTs very close to the EGJ underwent ELFR with laparoscopic two-layer suturing at Kyungpook National University Medical Center. With the patient under general anesthesia, the lesser curvature and posterior aspect adjacent to the EGJ were meticulously dissected and visualized using a laparoscopic approach. A partially circumferential full-thickness incision at the distal margin of the tumor was then made using an endoscopic approach under laparoscopic guidance. The SMT was resected using laparoscopic ultrasonic shears, and the gastric wall was closed using two-layer suturing. Thereafter, the patency and any leakage were checked through endoscopy. Results: All the ELFR procedures with laparoscopic two-layer suturing were performed successfully without an open conversion. The mean operation time was $139.2{\pm}30.9$ minutes and the blood loss was too minimal to be measured. The tumors from four patients were leiomyomas, while the tumors from the other two patients were gastrointestinal stromal tumors with clear resection margins. All the patients started oral intake on the third postoperative day. There was no morbidity or mortality. The mean hospital stay was $7.7{\pm}0.8$ days. Conclusions: ELFR with laparoscopic two-layer suturing is a safe treatment option for patients with an SMT close to the EGJ, as major resection of the stomach is avoided.

Keywords

References

  1. Hedenbro JL, Ekelund M, Wetterberg P. Endoscopic diagnosis of submucosal gastric lesions. The results after routine endoscopy. Surg Endosc 1991;5:20-23. https://doi.org/10.1007/BF00591381
  2. Ponsaing LG, Kiss K, Hansen MB. Classification of submucosal tumors in the gastrointestinal tract. World J Gastroenterol 2007;13:3311-3315. https://doi.org/10.3748/wjg.v13.i24.3311
  3. Berindoague R, Targarona EM, Feliu X, Artigas V, Balague C, Aldeano A, et al. Laparoscopic resection of clinically suspected gastric stromal tumors. Surg Innov 2006;13:231-237. https://doi.org/10.1177/1553350606295960
  4. 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; discussion 745-747. https://doi.org/10.1097/01.sla.0000219739.11758.27
  5. Sexton JA, Pierce RA, Halpin VJ, Eagon JC, Hawkins WG, Linehan DC, et al. Laparoscopic gastric resection for gastrointestinal stromal tumors. Surg Endosc 2008;22:2583-2587. https://doi.org/10.1007/s00464-008-9807-1
  6. Sasaki A, Koeda K, Obuchi T, Nakajima J, Nishizuka S, Terashima M, et al. Tailored laparoscopic resection for suspected gastric gastrointestinal stromal tumors. Surgery 2010;147:516-520. https://doi.org/10.1016/j.surg.2009.10.035
  7. Choi YB, Oh ST. Laparoscopy in the management of gastric submucosal tumors. Surg Endosc 2000;14:741-745. https://doi.org/10.1007/s004640000148
  8. Abe N, Takeuchi H, Yanagida O, Masaki T, Mori T, Sugiyama M, et al. Endoscopic full-thickness resection with laparoscopic assistance as hybrid NOTES for gastric submucosal tumor. Surg Endosc 2009;23:1908-1913. https://doi.org/10.1007/s00464-008-0317-y
  9. Blay JY, Bonvalot S, Casali P, Choi H, Debiec-Richter M, Dei Tos AP, et al; GIST consensus meeting panelists. Consensus meeting for the management of gastrointestinal stromal tumors. Report of the GIST Consensus Conference of 20- 21 March 2004, under the auspices of ESMO. Ann Oncol 2005;16:566-578. https://doi.org/10.1093/annonc/mdi127
  10. Demetri GD, von Mehren M, Antonescu CR, DeMatteo RP, Ganjoo KN, Maki RG, et al. NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Canc Netw 2010;8 Suppl 2:S1-S41; quiz S42-S44.
  11. Nishida T, Hirota S, Yanagisawa A, Sugino Y, Minami M, Yamamura Y, et al; GIST Guideline Subcommittee. Clinical practice guidelines for gastrointestinal stromal tumor (GIST) in Japan: English version. Int J Clin Oncol 2008;13:416-430. https://doi.org/10.1007/s10147-008-0798-7
  12. Song KY, Kim SN, Park CH. Tailored-approach of laparoscopic wedge resection for treatment of submucosal tumor near the esophagogastric junction. Surg Endosc 2007;21:2272-2276. https://doi.org/10.1007/s00464-007-9369-7
  13. Hiki N, Yamamoto Y, Fukunaga T, Yamaguchi T, Nunobe S, Tokunaga M, et al. Laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor dissection. Surg Endosc 2008;22:1729-1735. https://doi.org/10.1007/s00464-007-9696-8
  14. Hwang SH, Park do J, Kim YH, Lee KH, Lee HS, Kim HH, et al. Laparoscopic surgery for submucosal tumors located at the esophagogastric junction and the prepylorus. Surg Endosc 2009;23:1980-1987. https://doi.org/10.1007/s00464-008-9955-3
  15. Shim JH, Lee HH, Yoo HM, Jeon HM, Park CH, Kim JG, et al. Intragastric approach for submucosal tumors located near the Z-line: a hybrid laparoscopic and endoscopic technique. J Surg Oncol 2011;104:312-315. https://doi.org/10.1002/jso.21934
  16. Li QL, Yao LQ, Zhou PH, Xu MD, Chen SY, Zhong YS, et al. Submucosal tumors of the esophagogastric junction originating from the muscularis propria layer: a large study of endoscopic submucosal dissection (with video). Gastrointest Endosc 2012;75:1153-1158. https://doi.org/10.1016/j.gie.2012.01.037
  17. Katoh T, Itoh Y, Mohri T, Suzuki H. Endoscopic enucleation of gastrointestinal stromal tumors of the stomach: report of five cases. World J Gastroenterol 2008;14:2609-2611. https://doi.org/10.3748/wjg.14.2609
  18. Kang YK, Kim KM, Sohn T, Choi D, Kang HJ, Ryu MH, et al; Korean GIST Study Group. Clinical practice guideline for accurate diagnosis and effective treatment of gastrointestinal stromal tumor in Korea. J Korean Med Sci 2010;25:1543-1552. https://doi.org/10.3346/jkms.2010.25.11.1543
  19. Tagaya N, Mikami H, Kogure H, Kubota K, Hosoya Y, Nagai H. Laparoscopic intragastric stapled resection of gastric submucosal tumors located near the esophagogastric junction. Surg Endosc 2002;16:177-179. https://doi.org/10.1007/s004640080158
  20. Sakamoto Y, Sakaguchi Y, Akimoto H, Chinen Y, Kojo M, Sugiyama M, et al. Safe laparoscopic resection of a gastric gastrointestinal stromal tumor close to the esophagogastric junction. Surg Today 2012;42:708-711. https://doi.org/10.1007/s00595-012-0121-0
  21. Abe N, Mori T, Takeuchi H, Ueki H, Yanagida O, Masaki T, et al. Successful treatment of early stage gastric cancer by laparoscopy-assisted endoscopic full-thickness resection with lymphadenectomy. Gastrointest Endosc 2008;68:1220-1224. https://doi.org/10.1016/j.gie.2008.02.077

Cited by

  1. Endoscopic Full-Thickness Resection Combined with Laparoscopic Surgery vol.51, pp.1, 2015, https://doi.org/10.5946/ce.2017.153
  2. Transgastric and Reverse Sleeve Resection of Gastric Submucosal Tumors: Analysis of 7 Cases vol.91, pp.2, 2015, https://doi.org/10.1007/s13126-019-0511-5
  3. Laparoscopic Local Resection through Subserosal Dissection with Endoscopic Air-Insufflation for Submucosal Tumors Located Near the Esophagogastric Junction vol.23, pp.4, 2015, https://doi.org/10.7602/jmis.2020.23.4.172