Winder Alec, Strauss Dirk C, Jones Robin L, Benson Charlotte, Messiou Christina, Chaudry Mohammed Asif, Smith Myles J
Department of Academic Surgery, Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden Hospital, London, UK.
Department of Radiology, The Royal Marsden Hospital, London, UK.
J Surg Oncol. 2020 Sep;122(4):691-698. doi: 10.1002/jso.26053. Epub 2020 Jun 2.
The aim of surgical treatment of gastrointestinal stromal tumors (GIST) is a microscopically complete resection. Initial indications for laparoscopic surgery were limited to smaller tumors, in favorable locations. Over time, indications for minimal invasive surgery (MIS) have expanded, however concerns remain when considering resection of larger GISTs. Our aims were to assess the utility of robotic resection of gastric GISTs for challenging tumors.
GIST resections, in this study were performed using the Intuitive Da Vinci Surgical Xi System. GIST's were considered challenging if tumor size was >50 mm at the time of surgery and/or the location of the tumor was type II, III, or IV using Privette/Al-Thanai classification.
Robotic resections were performed on 12 consecutive patients, 83% were considered challenging cases, 6 out of 12 for location and 5 out of 12 for size. Initial median tumor size on imaging was 53.7 mm, and post-imatinib was 45.8 mm. All tumors were removed with clear margins (R0) via wedge resections, with no complications. Median operative time was 192 minutes (95-250). Length of hospital stay was 2 days (2-6).
Robotic resection of gastric GIST's appears oncologically safe, and may expand the benefits of MIS to a greater cohort of complex cases.
胃肠道间质瘤（GIST）手术治疗的目标是实现显微镜下的完整切除。腹腔镜手术的最初适应证仅限于位置良好的较小肿瘤。随着时间的推移，微创手术（MIS）的适应证有所扩大，但在考虑切除较大的GIST时仍存在担忧。我们的目的是评估机器人切除胃GIST对具有挑战性肿瘤的实用性。
在本研究中，GIST切除使用直观达芬奇Xi手术系统进行。如果手术时肿瘤大小>50mm和/或根据Privette/Al-Thanai分类肿瘤位置为II型、III型或IV型，则认为GIST具有挑战性。
连续对12例患者进行了机器人切除术，其中83%被认为是具有挑战性的病例，12例中有6例是因为位置，12例中有5例是因为大小。影像学上最初的肿瘤中位大小为53.7mm，使用伊马替尼后为45.8mm。所有肿瘤均通过楔形切除术实现切缘阴性（R0）切除，无并发症。中位手术时间为192分钟（95 - 250分钟）。住院时间为2天（2 - 6天）。
机器人切除胃GIST在肿瘤学上似乎是安全的，并且可能将MIS的益处扩展到更多复杂病例群体。
