Laparoscopic Enucleation or Wedge Resection of Benign Gastric Pathology: Analysis of 44 Consecutive Cases

Laparoscopic resection of gastric submucosal tumors has been described, but the role of laparoscopy for tumors within the esophagus or near the gastroesophageal junction is not clearly defined. The aim of this study was to examine the outcomes of laparoscopic or thoracoscopic enucleation or wedge resection of benign gastric tumors. The charts of 44 patients who underwent minimally invasive resection of benign esophagogastric tumors were reviewed. Surgical approaches included thoracoscopic enucleation (n = 2), laparoscopic enucleation (n = 6), transgastric enucleation (n = 2), and laparoscopic gastric wedge resection (n = 34). There were 23 males with a mean age of 57 years. There was one conversion (2.5%) to laparotomy. Mean operative time was 97 ± 52 minutes. The mean length of hospital stay was 2.6 ± 2.0 days. One patient developed gastric outlet obstruction requiring Roux-en-Y reconstruction. There were no leaks and the 90-day mortality was zero. Pathology demonstrated gastrointestinal stromal tumor (n = 31), leiomyoma (n = 6), and other benign pathology (n = 7). There has been one tumor recurrence at a mean follow-up of 4.3 years. The laparoscopic approaches to local resection of gastric tumors are safe and feasible. The type of minimally invasive surgical approaches should be tailored based on the location and size of the lesion.

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Minimally Invasive Resection of Benign Gastric Tumors in Challenging Locations: Prepyloric Region or Gastroesophageal Junction

The American Surgeon ◽

10.1177/000313481307901002 ◽

2013 ◽

Vol 79 (10) ◽

pp. 968-972 ◽

Cited By ~ 1

Author(s):

Christopher Armstrong ◽

Alana Gebhart ◽

Brian R. Smith ◽

Ninh T. Nguyen

Keyword(s):

Minimally Invasive ◽

Perioperative Complications ◽

Wedge Resection ◽

Gastroesophageal Junction ◽

Surgical Techniques ◽

Surgical Approaches ◽

Anatomic Resection ◽

Submucosal Tumors ◽

Gastric Tumors ◽

Minimally Invasive Surgical

Benign gastric tumors in a prepyloric location or within 3 cm adjacent of the gastroesophageal junction (GEJ) are often challenging to resect using minimally invasive surgical techniques. The aim of this study was to examine the outcomes of patients who underwent minimally invasive enucleation or resection of benign gastric tumors at these difficult locations. The charts of patients undergoing minimally invasive resection of benign-appearing submucosal gastric tumors between June 2001 and December 2012 were reviewed. Data on tumor size and location, type of minimally invasive surgical resection, perioperative complications, 90-day mortality, pathology, and recurrence were collected. A total of 70 consecutive patients underwent laparoscopic resection of benign-appearing submucosal gastric tumors; there were 24 patients with lesions close to the GEJ and nine patients with lesions close to the prepyloric region. All lesions were successfully resected laparoscopically. For prepyloric tumors, surgical approaches included enucleation (n = 1), wedge resection (n = 2), and distal gastrectomy with reconstruction (n = 6). For tumors close to the GEJ, surgical approaches included enucleation (n = 16), wedge resection (n = 3), and esophagogastrectomy (n = 5). Complications in this series of 33 patients included late strictures requiring endoscopic dilation in three patients who underwent esophagogastrectomy. The 90-day mortality rate was zero. There were no recurrences over a mean follow-up of 15 months (range, 1 to 86 months). Minimally invasive enucleation or formal anatomic resection of submucosal tumors located adjacent to the GEJ or at the prepyloric region is safe and carries a low risk for tumor recurrence. Submucosal gastric lesions adjacent to the GEJ are amenable to laparoscopic enucleation or wedge resection unless they extend proximally into the esophagus. Prepyloric lesions often require formal anatomic resection with reconstruction.

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PS01.047: PROPHYLACTIC ANTI-REFLUX SURGERY AFTER LAPAROSCOPIC GASTRIC WEDGE RESECTIONS FOR GASTRIC SUBMUCOSAL TUMORS OF GASTROESOPHAGEAL JUNCTION

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.047 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 63-63

Author(s):

Chang Hyun Kim ◽

Jin-Jo Kim

Keyword(s):

Conflicts Of Interest ◽

Submucosal Tumor ◽

Wedge Resection ◽

Gastroesophageal Junction ◽

Submucosal Tumors ◽

Gastric Submucosal Tumors ◽

Increased Risk ◽

Group A ◽

Group B ◽

Gerd Symptoms

Abstract Background A laparoscopic wedge resection (LWR) for a gastric submucosal tumor (SMT) close to gastroesophageal junction (GEJ) is technically challenging due to increased risk of damage to the lower esophageal sphincter. We hypothesized that GERD would be less prevalent if a prophylactic anti-reflux surgery (ARS) was added after this surgery. The aim of this study is to analyze our experience of prophylactic ARS after LWR for a gastric SMT close to GEJ Methods We retrospectively collected data from 51 patients who diagnosed with SMT of near the GEJ and who underwent LWR between January 2000 and December 2017. The patients were divided into 2 groups, the patient with prophylactic ARS (group A) or not (group B). Results There was no difference in the frequency of the preoperative GERD symptoms between the 2 groups, whereas postoperative GERD symptoms and postoperative use of acid suppressive medications were more frequent in the group B (P = 0.032, P = 0.036). However, there were no differences in the follow-up endoscopic findings in terms of reflux esophagitis and Hill's grade between the 2 groups. Conclusion The prophylactic ARS after LWR for SMT close to GEJ is an effective method of prevent gastroesophageal reflux symptoms after surgery. Disclosure All authors have declared no conflicts of interest.

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Laparoscopic Wedge Resection of Gastric Submucosal Tumors

Digestive Surgery ◽

10.1159/000064209 ◽

2002 ◽

Vol 19 (3) ◽

pp. 169-173 ◽

Cited By ~ 25

Author(s):

S. Shimizu ◽

H. Noshiro ◽

E. Nagai ◽

A. Uchiyama ◽

K. Mizumoto ◽

...

Keyword(s):

Wedge Resection ◽

Laparoscopic Wedge Resection ◽

Submucosal Tumors ◽

Gastric Submucosal Tumors

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Laparoscopic Wedge Resection of Gastric Submucosal Tumors

Surgical Laparoscopy Endoscopy & Percutaneous Techniques ◽

10.1097/00129689-200002000-00005 ◽

2000 ◽

Vol 10 (1) ◽

pp. 19-23 ◽

Cited By ~ 21

Author(s):

Yoshihide Otani ◽

Masahiro Ohgami ◽

Naoki Igarashi ◽

Masaru Kimata ◽

Tetsuro Kubota ◽

...

Keyword(s):

Wedge Resection ◽

Laparoscopic Wedge Resection ◽

Submucosal Tumors ◽

Gastric Submucosal Tumors

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Laparoscopic Wedge Resection for Gastric Submucosal Tumors: A Size-Location Matched Case-Control Study

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2010.10.008 ◽

2011 ◽

Vol 212 (2) ◽

pp. 195-199 ◽

Cited By ~ 34

Author(s):

Han Hong Lee ◽

Hoon Hur ◽

Hun Jung ◽

Cho Hyun Park ◽

Hae Myung Jeon ◽

...

Keyword(s):

Case Control Study ◽

Wedge Resection ◽

Case Control ◽

Laparoscopic Wedge Resection ◽

Submucosal Tumors ◽

Gastric Submucosal Tumors ◽

Matched Case ◽

Matched Case Control Study ◽

Control Study

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Gastric Glomus Tumor: A Rare Cause of Upper Gastrointestinal Bleeding

Case Reports in Surgery ◽

10.1155/2015/193684 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Yoshinori Handa ◽

Mikihiro Kano ◽

Mayumi Kaneko ◽

Naoki Hirabayashi

Keyword(s):

Glomus Tumor ◽

Submucosal Tumor ◽

Wedge Resection ◽

Gastric Wall ◽

Glomus Tumors ◽

Submucosal Tumors ◽

Gastric Submucosal Tumors ◽

Upper Gastrointestinal ◽

Tomography Scan ◽

Immunohistological Analysis

A 24-year-old woman was referred to our department because of melena. These symptoms combined with severe anemia prompted us to perform an emergency upper endoscopy, which showed bleeding from an ulcerated 30 mm submucosal tumor in the gastric antrum. A computed tomography scan revealed a homogeneously enhanced mass, and endoscopic ultrasonography identified a well-demarcated mass in the third and fourth layers of the gastric wall. Because analysis of the possible medical causes remained inconclusive and the risk of rebleeding, laparoscopy-assisted gastric wedge resection was performed after administration of 10 units of red cell concentrate. Histological and immunohistological analysis revealed the tumor to be a gastric glomus tumor. Gastric submucosal tumors remain challenging to diagnose preoperatively as they show a variety of radiologic and clinicopathologic features and are associated with the risk of bleeding upon biopsy, as is indicated in the guidelines for gastric submucosal tumors. Gastric glomus tumors characteristically present with exsanguinating gastrointestinal hemorrhaging that often requires blood transfusion. Additionally, gastric submucosal tumors typically occur in elderly patients; however, this case involved a young patient who was 24 years old. Here, we describe this case in order to identify features that may aid in early differentiation of gastric submucosal tumors.

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