Ortenzi Monica, Ghiselli Roberto, Cardinali Luca, Guerrieri Mario
Ann Ital Chir. 2017;88.
Gastrointestinal stromal tumors (GIST) are quite rare tumors, but yet they are the most common mesenchymal lesions of gastrointestinal tract. Their outmost frequent origin site is stomach and presently surgical resection is the mainstay in the treatment of gastric non metastatic GIST. Their peculiar characteristic of growth and poor metastatic tendency make this tumors particularly prone to be managed by minimally invasive technique. Presenting our experience we want show the feasibility and safeness of laparoscopic approach for gastric GIST and its benefits versus traditional open surgery and pointing out short term and long terms outcomes.
In our series we included 60 patients who underwent surgery for gastric GIST from 2004 to 2014 at Clinica Chirurgica of Università Politecnica delle Marche. Patients were divided in two group according with surgical approach (open or laparoscopic). Criteria of exclusion were metastatic disease and palliative purpose of surgical resection. All patients underwent endoscopic ultrasonography, fine needle aspiration, TC/MRI or PET before surgery. However most of the definitive diagnosis were postoperative. CD117 and CD34 immunohistochemical positivity were considered suggestive for GIST. Tumors were classified in four different prognostic groups according with pathological findings (size and mitotic count) as reported in Fletcher classification. None of the patients received Imatinib before surgery. All patients underwent follow-up with Computerized Tomography (TC) and/or Magnetic Resonance (MRI) repeated every year (mean 51.98 ± 35.68 months).
We performed open surgery on 22 patients (36.7%) and laparoscopic wedge resection on 38 patients (63.33%); one of these underwent robotic wedge resection by da the da Vinci® surgical system. The median age at diagnosis was 64 years (range= 45-71). Patients with gastric GIST presented with various symptoms, including fatigue secondary to anemia, intraluminal gastrointestinal bleeding, abdominal pain, abdominal mass, vomiting and syncope. In 26 patients (43.3%) gastric GISTs were detected incidentally during abdominal exploration, endoscopy, or radiologic imaging. Tumor dimensional difference between the two groups was not significant (mean 4.75 cm, range= 2-13). Operation time was significantly lower in laparoscopic approach (82.4 versus 117.8 min). We did not experience of intraoperative or post-operative complications in laparoscopic group. Conversely 4 patients of open group were transfused for anemia. In our series we didn't observe recurrence or metastasis at mean follow up period of (range= 49-120 months).
Laparoscopic surgery is a minimally invasive approach to the treatment of GISTs and offers many advantages such as short hospital stay and low morbidity. In the meantime oncological outcomes of laparoscopy for gastric GIST, assessed as tumor free resection margins and recurrence rate, are comparable to traditional open strategy.
Gastrointestinal stromal tumors, Laparoscopy, Minimally invasive surgery, Stomach.
胃肠道间质瘤（GIST）是相当罕见的肿瘤，但却是胃肠道最常见的间质性病变。其最常见的起源部位是胃，目前手术切除是胃非转移性GIST治疗的主要手段。其独特的生长特性和较差的转移倾向使得这类肿瘤特别适合采用微创技术进行处理。通过展示我们的经验，我们希望表明腹腔镜手术治疗胃GIST的可行性和安全性，以及与传统开放手术相比的优势，并指出短期和长期结果。
我们的研究系列纳入了2004年至2014年在马尔凯理工大学临床外科接受胃GIST手术的60例患者。根据手术方式（开放或腹腔镜）将患者分为两组。排除标准为转移性疾病和手术切除的姑息性目的。所有患者在手术前均接受了内镜超声检查、细针穿刺、TC/MRI或PET检查。然而，大多数明确诊断是在术后做出的。CD117和CD34免疫组化阳性被认为提示GIST。根据弗莱彻分类法中报告的病理结果（大小和有丝分裂计数），将肿瘤分为四个不同的预后组。所有患者在手术前均未接受伊马替尼治疗。所有患者均接受每年重复进行的计算机断层扫描（TC）和/或磁共振成像（MRI）随访（平均51.98±35.68个月）。
我们对22例患者（36.7%）进行了开放手术，对38例患者（63.33%）进行了腹腔镜楔形切除术；其中1例通过达芬奇®手术系统进行了机器人楔形切除术。诊断时的中位年龄为64岁（范围=45 - 71岁）。胃GIST患者表现出各种症状，包括贫血继发的疲劳、腔内胃肠道出血、腹痛、腹部肿块、呕吐和晕厥。26例患者（43.3%）在腹部探查、内镜检查或影像学检查中偶然发现胃GIST。两组之间的肿瘤大小差异不显著（平均4.75 cm，范围=2 - 13）。腹腔镜手术的手术时间明显更短（82.4分钟对117.8分钟）。腹腔镜组未发生术中或术后并发症。相反，开放组有4例患者因贫血接受了输血治疗。在我们的研究系列中，平均随访期（范围=49 - 120个月）未观察到复发或转移。
腹腔镜手术是治疗GIST的一种微创方法，具有住院时间短和发病率低等诸多优点。同时，评估为无瘤切除边缘和复发率的腹腔镜治疗胃GIST的肿瘤学结果与传统开放手术相当。
胃肠道间质瘤；腹腔镜检查；微创手术；胃
