Y. Shoji1, H. Takeuchi1, H. Kawakubo1, O. Goto2, R. Nakamura2, T. Takahashi2, N. Wada1, Y. Saikawa1, T. Omori1, N. Yahagi2, Y. Kitagawa1 1Keio University School Of Medicine,Department Of Surgery,Tokyo, TOKYO, Japan 2Keio University School Of Medicine,Tumor Center,Tokyo, TOKYO, Japan
Introduction:
Because gastric submucosal tumors including gastrointestinal stromal tumor can be treated with local resection without lymph-node dissection, laparoscopic local resection (LAP) is widely used to manage relatively small tumors less than 5cm in diameter. To make the operation less invasive, new surgical strategies such as single incision laparoscopic surgery (SILS), laparoscopy endoscopy cooperative surgery (LECS) and non-exposed endoscopic wall-inversion surgery (NEWS) were developed.
Methods:
In this study, we made a comparative review of the patient’s characteristics, surgical outcome, postoperative courses of each procedure.
Results:
From January 2004 to June 2014, 130 patients with gastric submucosal tumor underwent surgical treatment in Department of Surgery, Keio University School of Medicine. Eighty-two patients received minimally invasive surgery mentioned above. Detail of the patients were LAP 53, SILS 11, LECS 11, NEWS 7 (other surgical procedure were as follows; open surgery 17, hand assisted laparoscopic surgery 6, laparoscopy assisted proximal gastrectomy 6, laparoscopy assisted distal gastrectomy 3, laparoscopy assisted pylorus preserving gastrectomy 2, endoscopic submucosal dissection 3, other laparoscopic surgery 7. 4 patients in LAP group were excluded because of combined resection of other organs).
There were no significant differences in patient characteristics such as age, sex, body mass index and the size nor the growth pattern of the tumor. LAP and SILS were not indicated to tumors of the esophagogastric junction (p<0.001).Mean operative duration of the LAP and SILS group was significantly shorter than the LECS and NEWS group (p<0.05). There were no differences in intraoperative blood loss among the groups.The mean value of C-reactive protein of the 1st postoperative day was significantly higher in the LECS group in comparison to other groups (p<0.05). There was no significant difference in postoperative hospitalization between the groups. There were totally 4 cases with postoperative complications (acute appendicitis, splenic vein thrombosis, stenosis, toxicodermatitis). Every patient recovered with conservative measures without sequelae. Other patients discharged with an uneventful recovery.
Conclusion:
LAP and SILS were not selected to treat the tumor of the esophagogastric junction in order to prevent the postoperative stricture of the cardia by its relatively wide extent of resection(p<0.001). On the 1st postoperative day, the value of CRP, as an indicator of inflammatory reaction was significantly higher in the LECS group (p<0.05). The reason is expected that LECS is the only surgical form in which the digestive fluid expose to the body cavity.
Operative procedure for gastric submucosal tumor must be chosen studiously by the patient’s characteristics and the tumor property. However, NEWS is suggested to be a widely applied, less invasive technique, which should be introduced positively.