Department of Surgery, Division of General Surgery, Thomas Jefferson University, Fifth Floor Medical Office Building, 1100 Walnut Street, Philadelphia, PA 19107, USA.
Surg Endosc. 2012 Dec;26(12):3509-14. doi: 10.1007/s00464-012-2374-5. Epub 2012 Jun 9.
Gastrointestinal stromal tumors (GIST) are uncommon gastric neoplasms, which are typically treated by surgical excision. During the past 10 years, our institution has gained experience in resecting these tumors by minimally invasive methods. The purpose of this study is to review our experience with laparoscopic resection, report our short-term outcomes, and offer our perspective on the technical nuances involved in handling these neoplasms.
We retrospectively queried our prospectively maintained, institutional review board-approved database for all gastric GISTs resected from 2002 to 2012. We analyzed all cases that were resected via laparoscopy. Operative notes were reviewed for the technique employed. Data on tumor location, size, margin status, operative time, and blood loss were collected and analyzed.
During the 10-year study period, 104 gastric GISTs were resected. Laparoscopy was attempted in 58 cases with only one conversion to an open procedure. Tumors were separated based on anatomic zones. Forty-seven tumors (82%) were located on the body or fundus of the stomach (18 on the posterior wall and 29 on the anterior wall). Five GISTs (9%) were located at the gastroesophageal junction (GEJ). Five tumors (9%) were located at the antrum. The mean tumor size was 3.8 cm with a mean estimated blood loss of 40 ml. We achieved R0 resection in 100% of the cases. Most tumors (96%) were amenable to wedge resection. Tumors at the extremes of the stomach required variations of technique to achieve resection. Intraoperative endoscopy was selectively utilized.
As our experience with gastric GISTs has increased, laparoscopic resection has become our first-line treatment for most small- and moderate-sized tumors. By employing a structured approach to tumors along the entire stomach, laparoscopic resection of these tumors can be performed safely with adequate short-term results.
胃肠道间质瘤（GIST）是一种罕见的胃肿瘤，通常通过手术切除进行治疗。在过去的 10 年中，我们机构已经积累了通过微创方法切除这些肿瘤的经验。本研究旨在回顾我们的腹腔镜切除经验，报告我们的短期结果，并提供我们对处理这些肿瘤的技术细节的看法。
我们通过前瞻性维护的机构审查委员会批准的数据库，对 2002 年至 2012 年期间切除的所有胃 GIST 进行了回顾性查询。我们分析了所有通过腹腔镜切除的病例。查阅手术记录以了解所采用的技术。收集并分析肿瘤位置、大小、切缘状态、手术时间和出血量的数据。
在 10 年的研究期间，共切除了 104 例胃 GIST。尝试了 58 例腹腔镜手术，只有 1 例转为开放手术。根据解剖区域分离肿瘤。47 个肿瘤（82%）位于胃体或胃底（后壁 18 个，前壁 29 个）。5 个 GIST（9%）位于胃食管交界处（GEJ）。5 个肿瘤（9%）位于胃窦。肿瘤平均大小为 3.8cm，平均估计出血量为 40ml。我们在 100%的病例中实现了 R0 切除。大多数肿瘤（96%）适合楔形切除。胃的极端部位需要采用不同的技术来实现切除。选择性地使用了术中内镜。
随着我们对胃 GIST 经验的增加，腹腔镜切除已成为大多数小和中等大小肿瘤的首选治疗方法。通过对整个胃的肿瘤采用结构化方法，腹腔镜切除这些肿瘤可以安全地进行，并获得足够的短期结果。
