Second Department of Surgery, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
Surg Endosc. 2018 Jan;32(1):351-357. doi: 10.1007/s00464-017-5683-x. Epub 2017 Jun 29.
Laparoscopic wedge resection of the stomach is an ideal procedure if the gastric gastrointestinal stromal tumors (GISTs) are located in the extraluminal stomach. When the tumor is located in the intraluminal stomach, two minimally invasive surgical procedures involving laparoscopic and endoscopic cooperative surgery (LECS) or endoscopic intragastric surgery (EIGS) are frequently performed. To date, there have been no comparative studies of LECS and EIGS in patients with intraluminal gastric GISTs regarding short-term and long-term outcomes. The aim of this study was to compare the safety and feasibility of LECS and EIGS in patients with intraluminal gastric GISTs.
This was a single-center retrospective study of 46 consecutive patients with intraluminal gastric GISTs who underwent minimally invasive surgery. LECS (n = 21) was performed between 2013 and 2015 and EIGS (n = 26) was performed between 2001 and 2013.
The overall incidence of perioperative complications was significantly higher in the EIGS group than in the LECS group (40 vs 4.8%; P = 0.006). In the EIGS group, three patients with intraoperative gastric mucosal injury were followed-up throughout surgical repair (12%). An esophageal tear was found in one patient during oral removal of tumor (4%). Postoperative gastric hemorrhage occurred in three patients (12%) and superficial surgical site infection was observed in three patients (12%). In the LECS group, anastomotic leakage requiring additional drainage was observed in one patient (4.8%). EIGS had less favorable results regarding median time to resumption of first oral intake (2 vs 1 days; P = 0.005). Two of 46 patients (4.3%), including one patient who underwent LECS and one patient who underwent EIGS developed recurrence. No cause-specific deaths were observed.
LECS is a feasible and safe procedure for intraluminal gastric GISTs with regard to both short-term surgical and long-term oncological outcomes. Registration number: UMIN000026631.
如果胃胃肠间质瘤（GIST）位于胃外腔，腹腔镜楔形切除术是一种理想的手术方法。当肿瘤位于胃内腔时，常进行两种微创外科手术，即腹腔镜内镜联合手术（LECS）或内镜腔内手术（EIGS）。迄今为止，对于胃内腔 GIST 患者，LECS 和 EIGS 在短期和长期结果方面尚无比较研究。本研究旨在比较 LECS 和 EIGS 治疗胃内腔 GIST 患者的安全性和可行性。
这是一项单中心回顾性研究，纳入了 46 例接受微创外科手术的胃内腔 GIST 患者。LECS（n=21）于 2013 年至 2015 年进行，EIGS（n=26）于 2001 年至 2013 年进行。
EIGS 组围手术期并发症总发生率明显高于 LECS 组（40%比 4.8%；P=0.006）。EIGS 组 3 例术中胃黏膜损伤患者经手术修复后进行了全程随访（12%）。1 例患者在经口取出肿瘤时发生食管撕裂（4%）。术后发生 3 例胃出血（12%）和 3 例浅表手术部位感染（12%）。LECS 组中 1 例（4.8%）患者发生吻合口漏，需额外引流。EIGS 组患者首次口服恢复时间中位数明显更长（2 天比 1 天；P=0.005）。46 例患者中有 2 例（4.3%）复发，包括 1 例接受 LECS 治疗和 1 例接受 EIGS 治疗的患者。无病因特异性死亡。
LECS 是一种可行且安全的手术方法，适用于胃内腔 GIST，具有良好的短期手术和长期肿瘤学结果。注册号：UMIN000026631。
