J Gastric Cancer.  2015 Dec;15(4):231-237. 10.5230/jgc.2015.15.4.231.

Oncologic Safety of Laparoscopic Wedge Resection with Gastrotomy for Gastric Gastrointestinal Stromal Tumor: Comparison with Conventional Laparoscopic Wedge Resection

• Lee S
• Kim YN
• Son T
• Kim HI
• Cheong JH
• Hyung WJ
• Noh SH

• KMID: 2391557
• DOI: http://doi.org/10.5230/jgc.2015.15.4.231

Abstract

PURPOSE
Various laparoscopic wedge resection (LWR) techniques requiring gastrotomy for gastrointestinal stromal tumors (GISTs) of the stomach have been applied to facilitate tumor resection and preserve the remnant gastric volume. However, there is the possibility of cancer cell dissemination during these procedures. The aim of this study was to assess the oncologic safety of LWR with gastrotomy (LWR-G) compared to LWR without luminal exposure.
MATERIALS AND METHODS
Clinicopathologic and operative results of 193 patients who underwent LWR for gastric GIST were retrospectively analyzed from 2003 to 2013. We stratified the patients into two groups: LWR-G and LWR without gastrotomy (LWR-C). Clinicopathologic features, short-term outcomes, and long-term outcomes were compared.
RESULTS
A total of 26 patients underwent LWR-G, and 167 patients underwent LWR-C. The LWR-G group showed significantly more anterior wall-located (n=10, 38.5%), intraluminal (n=20, 76.9%), and ulcerative (n=13, 50.0%) tumors than the LWR-C group (n=33, 19.8%; n=96, 57.5%; n=46, 27.5%, respectively). Postoperative short-term outcomes did not differ between the two groups. When tumor staging was compared, no statistical difference was noted. There was no recurrence in the LWR-G group, while 2 patients in the LWR-C group experienced recurrence. The two recurrences in the LWR-C group were found in the liver and in the remnant stomach at 63 and 12 months after the operation, respectively. No gastric GIST-related death was recorded in any group during the study period.
CONCLUSIONS
LWR-G for gastric GIST is an oncologically safe procedure even for masses with ulcerations.

Keyword

Laparoscopy; Gastrointestinal stromal tumors; Recurrence; Stomach neoplasms

MeSH Terms

Gastric Stump
Gastrointestinal Stromal Tumors*
Humans
Laparoscopy
Liver
Neoplasm Staging
Phenobarbital
Recurrence
Retrospective Studies
Stomach
Stomach Neoplasms
Ulcer
Phenobarbital

Figure

• 

  Fig. 1 Patient disposition. GIST = gastrointestinal stromal tumor; LWR-G = laparoscopic wedge resection with gastrotomy; LWR-C = laparoscopic wedge resection without gastrotomy.

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