Kanehira Eiji, Kamei Aya, Umezawa Akiko, Kurita Atsushi, Tanida Takashi, Nakagi Masafumi
Department of Surgery, Medical Topia Soka, 1-11-18, Yatsuka, Soka-City, Saitama, 3400028, Japan.
Department of Surgery, Yotsuya Medical Cube, Tokyo, Japan.
Surg Endosc. 2016 May;30(5):2036-42. doi: 10.1007/s00464-015-4439-8. Epub 2015 Jul 23.
The treatment options for gastrointestinal stromal tumors (GITSs) at the esophagogastric junction (EGJ) are controversial. There have been reports on enucleation for EGJ GISTs in order to avoid gastrectomy. But the number of patients is too small, or the follow-up period is too short to evaluate it. The purpose of this study was to review our experience of 59 patients with EGJ GISTs treated by enucleation by percutaneous endoscopic intragastric surgery (PEIGS) and assess the clinical outcomes.
PEIGS is performed as described below. Access ports are placed through the abdominal wall and the anterior wall of the stomach. Through the access ports, an endoscope and surgical instruments are inserted into the gastric lumen and tumor enucleation and closure of the defect are carried out. In this study, 59 patients with EGJ GISTs treated by PEIGS between 2005 and 2013 were enrolled. Their hospital records were reviewed, and follow-up data for 8 years were collected to analyze the outcomes.
En-bloc enucleation was achieved without tumor rupture in all. Average operation time was 172.3 min. Postoperative complications occurred in 3 (one localized peritonitis, one bleeding, and one surgical site infection). Average tumor size was 35.6 mm. Pathological findings confirmed negative margin in all specimens. The maximum follow-up period was 101 months. Multiple liver metastases were detected in two patients (at 12 and 29 months). The survival rate was 100 %. The disease-free rate was 98.3 % at 12 months and 96.6 % at 29 months, respectively.
As far as the short- and long-term outcomes of our experience are reviewed, PEIGS seems as curative as other aggressive resection methods such as proximal gastrectomy. Tumor enucleation by PEIGS, offering a chance to preserve the stomach, can be a preferable option in carefully selected patients with EGJ GISTs, when performed by a skilled surgeon.
食管胃交界部（EGJ）胃肠道间质瘤（GITS）的治疗方案存在争议。有关于EGJ胃肠道间质瘤摘除术以避免胃切除术的报道。但患者数量过少，或随访期过短，无法对其进行评估。本研究的目的是回顾我们采用经皮内镜胃内手术（PEIGS）对59例EGJ胃肠道间质瘤患者进行摘除术的经验，并评估临床结果。
PEIGS按如下所述进行。通过腹壁和胃前壁放置接入端口。通过接入端口，将内镜和手术器械插入胃腔，进行肿瘤摘除和缺损闭合。本研究纳入了2005年至2013年间接受PEIGS治疗的59例EGJ胃肠道间质瘤患者。回顾了他们的医院记录，并收集了8年的随访数据以分析结果。
所有患者均实现了完整摘除，肿瘤无破裂。平均手术时间为172.3分钟。术后并发症发生3例（1例局限性腹膜炎、1例出血和1例手术部位感染）。平均肿瘤大小为35.6毫米。病理检查结果证实所有标本切缘阴性。最长随访期为101个月。两名患者（分别在12个月和29个月时）检测到多发肝转移。生存率为100%。无病生存率在12个月时为98.3%，在29个月时为96.6%。
就我们经验的短期和长期结果来看，PEIGS似乎与其他积极的切除方法如近端胃切除术一样具有治愈性。由熟练的外科医生进行时，PEIGS肿瘤摘除术为保留胃提供了机会，对于精心挑选的EGJ胃肠道间质瘤患者而言可能是一个更好的选择。
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