A. C. Pysher1, R. C. Langan1, S. Ram1, S. Morales1, R. S. Jackson1, R. Jha3, N. Haddad2, F. Al-Kawas2, J. Carroll2, P. G. Jackson1 1MedStar Georgetown University Hospital,Department Of General Surgery,Washington, DC, USA 2MedStar Georgetown University Hospital,Division Of Gastroenterology,Washington, DC, USA 3MedStar Georgetown University Hospital,Department Of Radiology,Washington, DC, USA
Introduction: Gastric submucosal tumors (SMTs) display a wide spectrum of pathologic and prognostic characteristics ranging from benign to highly malignant. Laparoscopic gastric wedge resections have become a commonly utilized treatment method. However, one of the challenges posed by use of the laparoscopic technique alone, is tumor identification. In this study, we provide a comprehensive analysis of SMTs at our institution and present a novel combined laparoscopic and endoscopic resection technique.
Methods: A retrospective review of a prospectively maintained SMT database was performed which identified 32 patients with gastric submucosal tumors who underwent a combined laparoscopic and endoscopic resection between 2006 and 2010. All clinicopatholgic data was analyzed.
Results: Pre-operative evaluation included upper endoscopy and endoscopic ultrasound with biopsy of visible lesions in all of patients. Operative technique utilized intraoperative endoscopic visualization of the lesion, followed by laparoscopic gastric wedge resection under direct endoscopic visualization. Utilizing the combined endoscopic and laparoscopic technique, SMTs were correctly identified in all cases. Final pathology revealed an R0 resection in 97% of patients (31/32). Mean tumor size was 2.48 cm (range, 0.6 to 6 cm) and final pathology revealed gastrointestinal stromal tumors (GISTs) in 18/32 cases. No intra-operative complications occurred. Post-operative course was uncomplicated in 29/32 patients. 3/32 patients experienced early post-operative complications, which included delayed gastric emptying, ileus, and small bowel obstruction. There were no perioperative deaths.
Conclusion: In one of the first series reporting a combined endoscopic and laparoscopic technique for SMTs, we found heightened identification of all SMTs not afforded by laparoscopy alone. This approach may have spared patients an open resection. Although we found this technique to be safe and efficacious, further studies should assess this novel approach using large nationally representative databases.