Ann Ital Chir. 2022 Nov 7;11:S2239253X22038750.
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. They are 1% of all gastrointestinal cancer and 60% of them affects the stomach. Up to 10% to 30% of GISTs are malignant. They occur in people over the age of 50 in both sexes. The most common symptoms of gastric GIST are bleeding, dyspepsia, vague abdominal pain or discomfort, and mass palpation. Some are asymptomatic and diagnosed incidentally. The first choice of treatment for primary localized gastric GISTs is surgery. The most suitable type of resection is not yet clear and it depends on size and location of tumor, especially for difficult localizations, such as subcardial, posterior wall and less curvature GISTs.
We report a rare case of a patient with subcardial gastric GIST treated with laparoscopic atypical quadrangular resection guided by intraoperative endoscopy. Furthermore, we performed a review of the literature about this topic.
Despite the difficult localization an atypical resection of the gastric GIST was performed without breaking the lesion but preserving the lumen of the esofagogastrich junction.
An atypical quadrangular resection for subcardial gastric GISTs, located along the posterior wall and lesser curvature, can be a safe and reliable alternative technique. However, we believe that it should be performed by an experienced surgeon and endoscopist to decrease the risk of mass's break and the narrowing of the cardial region's lumen. In our literature's knowledge there aren't cases treated with this technique.
Gastric GIST, Gastrointestinal stromal tumors, Intraoperative endoscopy, Laparoscopic resection, Minimally invasive surgery.
胃肠道间质瘤（GIST）是胃肠道最常见的间叶性肿瘤。它们占所有胃肠道癌的 1%，其中 60%发生在胃。高达 10%至 30%的 GIST 是恶性的。它们发生在 50 岁以上的男女两性。胃 GIST 的最常见症状是出血、消化不良、模糊腹痛或不适以及肿块触诊。有些是无症状的，是偶然诊断出来的。原发性局限性胃 GIST 的首选治疗方法是手术。最适合的切除类型尚不清楚，这取决于肿瘤的大小和位置，特别是对于难以定位的肿瘤，如心下、后壁和小弯部 GIST。
我们报告了一例心下胃 GIST 患者的罕见病例，该患者接受了术中内窥镜引导的腹腔镜非典型四边形切除术。此外，我们还对该主题进行了文献回顾。
尽管定位困难，但仍进行了非典型胃 GIST 切除术，未破坏病变，但保留了食管胃交界处的管腔。
对于位于后壁和小弯部的心下胃 GIST，可以采用非典型四边形切除术作为一种安全可靠的替代技术。然而，我们认为，应该由经验丰富的外科医生和内窥镜医生来进行，以降低肿块破裂和贲门区域管腔狭窄的风险。在我们的文献知识中，没有用这种技术治疗的病例。
胃 GIST、胃肠道间质瘤、术中内窥镜、腹腔镜切除术、微创手术。
