Honda Michitaka, Hiki Naoki, Nunobe Souya, Ohashi Manabu, Kiyokawa Takashi, Sano Takeshi, Yamaguchi Toshiharu
Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan,
Surg Endosc. 2014 Aug;28(8):2317-22. doi: 10.1007/s00464-014-3459-0. Epub 2014 Feb 25.
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. Surgical resection with a free margin is the gold standard treatment for these lesions.
The aim of this study was to evaluate the feasibility of performing laparoscopic resection for gastric GIST from the viewpoint of operative and long-term oncological outcomes.
Between 2005 and 2011, a total of 78 consecutive patients undergoing laparoscopic resection of gastric GISTs were enrolled in a retrospective single-center study. Patient and tumor characteristics, surgical procedures, risk classification, postoperative complications, mortality, recurrence, and survival time were collected from a database, and the descriptive statistics were estimated.
Patients (N = 78; 32 males and 46 females) with a median age of 63 years (range 31-82) were evaluated. The tumors were located at the cardia (10.3%), upper stomach (59.0%), middle stomach (23.1), and lower stomach (7.7%). The mean size of the tumors was 34.7 ± 12.1 mm. The laparoscopic procedures included wedge resection (92.3%), such as laparoscopy and endoscopy cooperative surgery (51.3%), and gastrectomy (7.7%). All cases exhibited a pathologically negative margin. The mean operative time was 147.5 ± 63.8 min, and the mean estimated amount of blood loss was 17.8 ± 47.9 ml. The mean length of hospitalization was 9.4 ± 12.8 days. The incidence of perioperative complications higher than grade III was 2.6%, including two cases of anastomotic leakage. Regarding risk classification, low, intermediate and high were observed in 61, 6, and 11 cases, respectively. During a mean follow-up period of 45.3 ± 18.5 months, one patient experienced local recurrence in the omentum. Meanwhile, four patients died due to other diseases; all other patients survived.
Adequate oncologic resection was achieved in all cases. Laparoscopic surgery is a feasible option for gastric GISTs <5 cm.
胃肠道间质瘤（GISTs）是胃肠道最常见的间叶性肿瘤。切缘阴性的手术切除是这些病变的金标准治疗方法。
本研究旨在从手术和长期肿瘤学结局的角度评估腹腔镜切除胃GIST的可行性。
在2005年至2011年期间，一项回顾性单中心研究纳入了78例连续接受腹腔镜切除胃GIST的患者。从数据库中收集患者和肿瘤特征、手术方式、风险分类、术后并发症、死亡率、复发率和生存时间，并进行描述性统计。
评估了78例患者（32例男性和46例女性），中位年龄为63岁（范围31 - 82岁）。肿瘤位于贲门（10.3%）、胃上部（59.0%）、胃中部（23.1%）和胃下部（7.7%）。肿瘤平均大小为34.7±12.1mm。腹腔镜手术包括楔形切除术（92.3%），如腹腔镜与内镜联合手术（51.3%）和胃切除术（7.7%）。所有病例切缘病理均为阴性。平均手术时间为147.5±63.8分钟，平均估计失血量为17.8±47.9ml。平均住院时间为9.4±12.8天。围手术期并发症高于Ⅲ级的发生率为2.6%，包括2例吻合口漏。在风险分类方面，低、中、高风险分别见于61、6和11例。在平均45.3±18.5个月的随访期内，1例患者网膜出现局部复发。同时，4例患者因其他疾病死亡；所有其他患者均存活。
所有病例均实现了充分的肿瘤切除。腹腔镜手术是治疗<5cm胃GIST的可行选择。
