Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No. 1 Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China.
J Gastrointest Surg. 2018 Mar;22(3):402-413. doi: 10.1007/s11605-017-3628-2. Epub 2017 Nov 13.
Laparoscopic wedge resection (LWR) is used to treat gastric submucosal tumors (SMTs). However, LWR can injure the cardia if tumors are near the esophagogastric junction (EGJ), resulting in gastric stenosis. This study's purpose was to summarize our experience with endoscope-assisted LWR for gastric SMTs within 3 cm of the EGJ and to verify the procedure's feasibility and safety.
Data from 91 consecutive patients with gastric SMTs within 3 cm of the EGJ who underwent endoscope-assisted LWR at our hospital from 2007 to 2017 were obtained from a prospectively maintained database. The clinicopathological results, perioperative data, and long-term follow-up data were analyzed.
All patients successfully underwent endoscope-assisted LWR. The mean distance from tumor to EGJ was 2.43 ± 0.80 cm. Eighty-two patients underwent laparoscopic exogastric wedge resection (LEWR) and nine underwent laparoscopic transgastric wedge resection (LTWR). Mean operative time was 112.4 ± 48.8 min; mean blood loss was 36.8 ± 53.5 ml. Mean time to first flatus was 2.04 ± 0.68 days. Mean time to liquid intake was 2.53 ± 0.85 days. Mean postoperative hospital stay was 4.97 ± 1.80 days. Three patients (3.3%) had postoperative complications, all Clavien-Dindo grade I. The mean maximum tumor diameter was 3.00 ± 1.96 cm (range 0.5-10). LTWR was used more often than LEWR for SMTs in the posterior wall, those with intraluminal growth, and those closer to the EGJ. The mean follow-up time was 36.86 ± 29.73 months (range 3-126). There was no stenosis of EGJ or tumor recurrence. Sixteen patients (17.6%) complained of upper gastrointestinal symptoms during the follow-up, which were all relieved by usage of acid suppressive medications.
Endoscope-assisted LWR is safe, feasible, and effective for gastric SMTs near the EGJ. LTWR is preferable to LEWR for gastric SMTs in the posterior wall, those with intraluminal growth, and those closer to the EGJ.
腹腔镜楔形切除术（LWR）用于治疗胃黏膜下肿瘤（SMT）。然而，如果肿瘤靠近食管胃结合部（EGJ），LWR 可能会损伤贲门，导致胃狭窄。本研究的目的是总结我们在距离 EGJ 3cm 内的胃 SMT 内镜辅助 LWR 的经验，并验证该手术的可行性和安全性。
从 2007 年至 2017 年我院接受内镜辅助 LWR 的 91 例距离 EGJ 3cm 内的胃 SMT 患者的前瞻性数据库中获取数据。分析临床病理结果、围手术期数据和长期随访数据。
所有患者均成功接受内镜辅助 LWR。肿瘤距 EGJ 的平均距离为 2.43±0.80cm。82 例患者行腹腔镜外胃楔形切除术（LEWR），9 例行腹腔镜经胃楔形切除术（LTWR）。手术时间平均为 112.4±48.8min；平均出血量为 36.8±53.5ml。首次排气时间平均为 2.04±0.68 天。开始进液时间平均为 2.53±0.85 天。术后平均住院时间为 4.97±1.80 天。3 例（3.3%）发生术后并发症，均为 Clavien-Dindo Ⅰ级。肿瘤最大直径平均为 3.00±1.96cm（范围 0.5-10）。LTWR 更多地用于胃后壁、腔内生长和靠近 EGJ 的 SMT。平均随访时间为 36.86±29.73 个月（范围 3-126）。无 EGJ 狭窄或肿瘤复发。16 例（17.6%）在随访期间出现上消化道症状，均经使用抑酸药物缓解。
内镜辅助 LWR 治疗 EGJ 附近的胃 SMT 是安全、可行且有效的。LTWR 对于胃后壁、腔内生长和靠近 EGJ 的 SMT 优于 LEWR。
