Buchs Nicolas C, Bucher Pascal, Pugin François, Hagen Monika E, Morel Philippe
Department of Surgery, University Hospital Geneva, Geneva, Switzerland.
J Laparoendosc Adv Surg Tech A. 2010 Jun;20(5):411-5. doi: 10.1089/lap.2009.0385.
Laparoscopic resection of gastric gastrointestinal stromal tumor (GIST) has been shown as feasible and safe in terms of oncologic results. However, laparoscopic resection has been demonstrated to be mainly suitable for small, favorably localized GIST. The robotic approach may, by its characteristics, enable the surgeon to perform atypical gastrectomies in an unfavorable location (i.e., close to pylorus or cardia). Its use in oncologic gastric surgery has been poorly defined and has never been reported for GIST.
All patients who underwent robotic-assisted gastric resection for GIST at a single institution from 2006 to 2009 were prospectively followed-up.
There were 5 patients (3 men and 2 women), with a median age of 39 years (range, 32-74), who had a complete resection (R0). Two patients had a cardial GIST and 3 of the antrum. Median tumor sizes were of 5.5 cm (range, 4.2-7). According to Fletcher criteria, 4 tumors (80%) were classified as intermediate or high risk. No postoperative morbidity and mortality were noted. One patient had a conversion to open surgery because of a suspicion of diffuse adenocarcinoma on fresh frozen section and necessitated a total gastrectomy with a radical lymph node dissection. Median operation time was 192 minutes (range, 132-285). With a median follow-up of 18 months (range, 11-27), disease-free survival rate was 100%.
The da Vinci robot (Intuitive Surgical, Inc., Sunnyvale, CA) is a valuable instrument for oncologically safe resection with esogastric or duodenogastric junction preservation for an unfavorably located gastric GIST. Moreover, the three-dimensional, high-definition vision, instrument mobility, and ease of performing a difficult suturing enable a safe, large atypical gastrectomy, close to the pylorus or cardia.
腹腔镜切除胃胃肠道间质瘤（GIST）在肿瘤学结果方面已被证明是可行且安全的。然而，腹腔镜切除主要适用于体积小、位置良好的GIST。机器人手术方法因其特点，可能使外科医生能够在不利位置（即靠近幽门或贲门）进行非典型胃切除术。其在肿瘤性胃手术中的应用定义尚不明确，且从未有过GIST相关报道。
对2006年至2009年在单一机构接受机器人辅助胃切除治疗GIST的所有患者进行前瞻性随访。
共有5例患者（3例男性和2例女性），中位年龄39岁（范围32 - 74岁），均实现了根治性切除（R0）。2例患者患有贲门部GIST，3例患者患有胃窦部GIST。肿瘤中位大小为5.5 cm（范围4.2 - 7 cm）。根据弗莱彻标准，4例肿瘤（80%）被分类为中危或高危。未观察到术后并发症和死亡病例。1例患者因术中新鲜冰冻切片怀疑弥漫性腺癌而转为开放手术，需要行全胃切除术及根治性淋巴结清扫术。中位手术时间为192分钟（范围132 - 285分钟）。中位随访时间为18个月（范围11 - 27个月），无病生存率为100%。
达芬奇机器人（直观外科公司，加利福尼亚州桑尼维尔）是一种有价值的器械，可用于对位置不佳的胃GIST进行肿瘤学安全切除并保留食管胃或十二指肠胃交界处。此外，其三维高清视野、器械灵活性以及进行复杂缝合的便利性，使得在靠近幽门或贲门处进行安全、大型的非典型胃切除术成为可能。
