Crouthamel Matthew R, Kaufman Jedediah A, Billing Josiah P, Billing Peter S, Landerholm Robert W
Puget Sound Surgical Center, Edmonds, Washington.
Puget Sound Surgical Center, Edmonds, Washington.
Surg Obes Relat Dis. 2015 Sep-Oct;11(5):1025-8. doi: 10.1016/j.soard.2015.06.004. Epub 2015 Jun 10.
Laparoscopic sleeve gastrectomy (SG) is a well-tolerated and effective procedure for sustained weight loss and amelioration of weight-related co-morbidities. Rarely, unexpected pathology may be identified intraoperatively, which may alter the surgical plan. Gastrointestinal stromal tumors (GISTs) are among the more frequently encountered tumors and pose a particular concern because of their malignant potential. We review our findings of incidental tumors encountered during 1415 consecutive SGs.
Abnormal pathology records from all patients who underwent SG at our institution between 2009 and 2014 were reviewed. Patient demographic characteristics and clinical characteristics, tumor characteristics, including immunohistochemistry, operative course, and patient follow-up were reviewed.
There were 17 incidental gastric mesenchymal tumors identified (1.2%) in 1415 SG procedures. This included 12 GISTs (.8%), 2 schwannomas (.1%), and 3 leiomyomas (.3%). In the majority of cases (1210/1415), the gastric specimens were not reviewed by a pathologist because there were no gross abnormalities appreciated by the surgeon. The GISTs were between .3 and 2.9 cm, and all were low grade with negative margins. Patients with GISTs tended to be older (mean age 55±9.3 y) than the rest of the patients. There was no evidence of recurrence on follow-up.
Incidental gastric mesenchymal tumors are rarely encountered during SG. The vast majority were GISTs with an incidence of .8% in this population. Concomitant SG and tumor resection were feasible, without compromising the objectives of each. Complete tumor excision is necessary for tumors>2 cm.
腹腔镜袖状胃切除术（SG）是一种耐受性良好且有效的手术方法，可实现持续减重并改善与体重相关的合并症。术中偶尔会发现意外病变，这可能会改变手术方案。胃肠道间质瘤（GIST）是较常遇到的肿瘤之一，因其具有恶性潜能而备受关注。我们回顾了连续1415例SG手术中偶然发现的肿瘤的相关情况。
回顾了2009年至2014年期间在本机构接受SG手术的所有患者的异常病理记录。对患者的人口统计学特征和临床特征、肿瘤特征（包括免疫组化）、手术过程及患者随访情况进行了回顾。
在1415例SG手术中，共发现17例偶然发生的胃间质瘤（1.2%）。其中包括12例GIST（0.8%）、2例神经鞘瘤（0.1%）和3例平滑肌瘤（0.3%）。在大多数病例（1210/1415）中，由于外科医生未发现明显的大体异常，胃标本未送病理科医生检查。GIST的大小在0.3至2.9厘米之间，均为低级别，切缘阴性。患有GIST的患者往往比其他患者年龄更大（平均年龄55±9.3岁）。随访中未发现复发迹象。
SG手术中偶然发现胃间质瘤的情况很少见。绝大多数为GIST，在该人群中的发生率为0.8%。同时进行SG和肿瘤切除是可行的，且不影响各自的目标。对于直径>2厘米的肿瘤，完整切除肿瘤是必要的。
