Wang Sheng-Fu, Cheng Hao-Tsai, Hsu Jun-Te, Wu Chi-Huan, Chen Chun-Wei, Lin Chun-Jung, Sung Kai-Feng
Department of Gastroenterology and Hepatology, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan.
School of Medicine, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan.
J Pers Med. 2021 Aug 28;11(9):855. doi: 10.3390/jpm11090855.
Totally laparoscopic surgery for early gastric cancer and subepithelial tumors has been popularized worldwide, yet localization of early or small-sized tumors is a persistent challenge due to difficulty being identified with the lack of manual tactile sensation. Thus, accurate localization with tattooing before the surgery would help improve efficiency during surgery. There are multiple methods to localize tumors before laparoscopy, each with varying advantages and disadvantages. The use of endoscopic tattooing with dye has been carried out for several decades due to its safety, lower cost, and convenience. However, there is a lack of studies on endoscopic tattooing before totally laparoscopic resection.
To evaluate the effect of endoscopic tattooing with dye for gastric subepithelial tumors localization before laparoscopic resection and to evaluate the tattooing effect on different locations of tumors in stomach.
We retrospectively collected data of patients with gastric subepithelial tumors who underwent endoscopic tattooing before totally laparoscopic resection from 2017 to 2020 in a university affiliated medical center. All patients were analyzed for preoperative characteristics and then categorized into two groups based on tumor locations concerning the difficulty of laparoscopic surgery. The independent t test and Chi-square test were performed to compare perioperative outcome and complications between these two groups.
A total of 19 patients were included retrospectively at our center. The individuals were 5 male and 14 female patients with a mean age of 58.2 years old. Most patients had no symptoms, and the tumors were found incidentally in 12 patients (63%). All tumors were identified clearly during laparoscopic resection. The mean tumor size was 2.3 cm. The surgeries took an average of 111 min and a mean of 7 mL blood loss was found. All tumors had negative resection margins with no recurrence during follow-up. Gastrointestinal stromal tumor was the major pathologic diagnosis, found in 12 patients (63%), followed by the leiomyoma in 5 patients (26%). Only three patients had mild adverse effects after surgery and the symptoms were self-limited. Our analysis found no significant difference in preoperative patient characteristics and perioperative outcomes between patients with differing tumor locations.
This study is the first and largest report on endoscopic tattooing with dye before laparoscopic resection of gastric subepithelial tumor resection. Our results emphasize that endoscopic tattooing with dye is a safe and reliable method for localizing subepithelial tumors in the stomach prior to totally laparoscopic resection, with no correlation to where the tumor is located.
早期胃癌和上皮下肿瘤的全腹腔镜手术已在全球范围内得到推广，但由于缺乏手动触觉难以识别，早期或小尺寸肿瘤的定位一直是一项挑战。因此，术前通过纹身进行准确的定位将有助于提高手术效率。在腹腔镜检查前有多种肿瘤定位方法，每种方法都有不同的优缺点。由于其安全性、低成本和便利性，使用染料进行内镜纹身已经开展了几十年。然而，关于全腹腔镜切除术前内镜纹身的研究较少。
评估染料内镜纹身对腹腔镜切除术前胃上皮下肿瘤定位的效果，并评估纹身对胃内不同部位肿瘤的效果。
我们回顾性收集了2017年至2020年在一所大学附属医院中心接受全腹腔镜切除术前内镜纹身的胃上皮下肿瘤患者的数据。对所有患者的术前特征进行分析，然后根据腹腔镜手术的难度将患者分为两组。进行独立t检验和卡方检验以比较两组患者的围手术期结果和并发症。
我们中心共回顾性纳入了19例患者。其中男性5例，女性14例，平均年龄58.2岁。大多数患者无症状，12例患者（63%）的肿瘤是偶然发现的。在腹腔镜切除过程中所有肿瘤均被清晰识别。肿瘤平均大小为2.3厘米。手术平均耗时111分钟，平均失血量为7毫升。所有肿瘤切缘阴性，随访期间无复发。主要病理诊断为胃肠道间质瘤，12例患者（63%），其次是平滑肌瘤5例患者（26%）。只有3例患者术后有轻度不良反应，症状为自限性。我们的分析发现，不同肿瘤部位患者的术前特征和围手术期结果无显著差异。
本研究是关于腹腔镜切除胃上皮下肿瘤术前染料内镜纹身的首个也是最大规模的报告。我们的结果强调，染料内镜纹身是全腹腔镜切除术前定位胃上皮下肿瘤的一种安全可靠的方法，与肿瘤位置无关。
