scholarly journals LAPAROSCOPIC RESECTION OF GASTROINTESTINAL STROMAL TUMORS (GIST)

2016 ◽  
Vol 29 (1) ◽  
pp. 1-4 ◽  
Author(s):  
Marcelo de Paula Loureiro ◽  
Rômulo Augusto Andrade de ALMEIDA ◽  
Christiano Marlo Paggi Claus ◽  
Eduardo Aimoré Bonin ◽  
Antônio Moris Cury-Filho ◽  
...  
Keyword(s):  
Operative Time ◽  
Laparoscopic Resection ◽  
Postoperative Bleeding ◽  
Imatinib Treatment ◽  
Stromal Tumors ◽  
Single Center Experience ◽  
Absorbable Sutures ◽  
Mechanical Suture ◽  
Laparoscopic Techniques

Background : Gastrointestinal mesenchymal or stromal tumors (GIST) are lesions originated on digestive tract walls, which are treated by surgical resection. Several laparoscopic techniques, from gastrectomies to segmental resections, have been used successfully. Aim : Describe a single center experience on laparoscopic GIST resection. Method : Charts of 15 operated patients were retrospectively reviewed. Thirteen had gastric lesions, of which ten were sub epithelial, ranging from 2-8 cm; and three were pure exofitic growing lesions. The remaining two patients had small bowel lesions. Surgical laparoscopic treatment consisted of two distal gastrectomies, 11 wedge gastric resections and two segmental enterectomies. Mechanical suture was used in the majority of patients except on six, which underwent resection and closure using manual absorbable sutures. There were no conversions to open technique. Results : Mean operative time was 1h 29 min±92 (40-420 min). Average lenght of hospital stay was three days (2-6 days). There were no leaks, postoperative bleeding or need for reintervention. Mean postoperative follow-up was 38±17 months (6-60 months). Three patients underwent adjuvant Imatinib treatment, one for recurrence five months postoperatively and two for tumors with moderate risk for recurrence . Conclusion : Laparoscopic GIST resection, not only for small lesions but also for tumors above 5 cm, is safe and acceptable technique.

Incisional Hernia Risk after Hand-Assisted Laparoscopic Surgery

2012 ◽  
Vol 78 (8) ◽  
pp. 864-869 ◽  
Author(s):  
William S. Cobb ◽  
Alfredo M. Carbonell ◽  
Garrett M. Snipes ◽  
Brianna Knott ◽  
Viet Le ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Incisional Hernia ◽  
Operative Time ◽  
Group Versus ◽  
True Incidence ◽  
Hernia Formation ◽  
The Mean ◽  
Laparoscopic Techniques ◽  
Mean Time

Hand-assisted laparoscopic surgery (HALS) bridges traditional open surgery and pure laparoscopy. The HALS technique provides the necessary site for organ retrieval, reduces operative time, and realizes the postoperative benefits of laparoscopic techniques. Although the reported rates of incisional hernia should be theoretically low, we sought to determine our incidence of hernia after HALS procedures. A retrospective review of all HALS procedures was performed from July 2006 to June 2011. All patients who developed postoperative incisional hernias at the hand port site were confirmed by imaging or examination findings. Patient factors were reviewed to determine any predictors of hernia formation. Over the 5 years, 405 patients undergoing HALS procedures were evaluated: colectomy (264), nephrectomy (107), splenectomy/pancreatectomy (18), and ostomy reversal (10). The overall incidence of incisional hernia was 10.6 per cent. There were three perioperative wound dehiscences. The mean body mass index was significantly higher in the hernia group versus the no hernia cohort (32.1 vs 29.2 kg/m2; P = 0.001). The hernia group also had a higher incidence of renal disease (18.6 vs 7.2%; P = 0.018). Mean time to hernia formation was 11.4 months (range, 1 to 57 months). Follow-up was greater than 12 months in 188 (46%) of patients, in which the rate of incisional hernia was 17 per cent. The rate of incisional hernia formation after hand-assisted laparoscopic procedures is higher than the reported literature. Because the mean time to hernia development is approximately 1 year, it is important to follow these patients to this end point to determine the true incidence of incisional hernia after hand-assisted laparoscopy.

Elective open nephron-sparing surgery for renal masses: Single-center experience with 223 consecutive patients

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16139-e16139
Author(s):  
F. Francesca ◽  
G. Pomara ◽  
G. Campo ◽  
P. Casale
Keyword(s):  
Postoperative Bleeding ◽  
Oncologic Outcome ◽  
Nephron Sparing Surgery ◽  
Consecutive Series ◽  
Renal Masses ◽  
Single Center Experience ◽  
Nephron Sparing ◽  
Urinary Fistulas

e16139 Background: To present our experience with elective, open, nephron-sparing surgery for renal masses in a contemporary, consecutive series. Methods: In this retrospective study, records of all patients who underwent elective nephron-sparing surgery (E-NSS) between March 1997 and December 2007 at our institution were reviewed. The preoperative workup included laboratory analysis, renal ultrasonography and abdominal computed tomography. The histological findings, complications, and oncologic outcome were studied. Results: A total of 231 E-NSS were performed in 223 patients (82 females,141males; mean age 64 years). 62 “hot ischemia” procedures and 169 “cold ischemia”. The mean tumor size was 4.6 cm (1.1–12cm). 52 patients presented renal masses > 4cm. Renal cell carcinoma was present in 177 patients (76.6%), benign renal masses were diagnosed in in 54 pazienti (23.3%): angiomyolipoma (35%), oncocytoma (40%), complicated cyst (25%). Worthy of note among these 54 patients, pre-operative diagnosis was present in 12 patients. Moreover, 17 benign lesions (31%) were > 4 cm. Complication rate was 5.3% (12 pts): splenectomy (2.2%), nephrectomy because of postoperative bleeding (0.8%), urinary fistulas (0.8%). After a median follow-up of 84 months (range 5 to 120), no patient had developed local recurrence, 19 (8.9%) died for other causes, 2 (0.9%) died for other tumor. Conclusions: The results of this contemporary, monocenter experience underline the role of open, elective, nephron-sparing surgery for patients with renal masses, confirming good results even for renal masses > 4cm. These conclusions are particularly important considering that benign histologic findings were present in almost one forth of patients. No significant financial relationships to disclose.

Gastrointestinal Stromal Tumors: A Single Institution Experience of 176 Surgical Patients

2013 ◽  
Vol 79 (7) ◽  
pp. 657-665 ◽  
Author(s):  
Sarah B. Fisher ◽  
Steven C. Kim ◽  
David A. Kooby ◽  
Kenneth Cardona ◽  
Maria C. Russell ◽  
...  
Keyword(s):  
Gastrointestinal Stromal Tumors ◽  
Laparoscopic Resection ◽  
Positive Margin ◽  
Single Institution ◽  
Clinicopathologic Characteristics ◽  
Primary Tumors ◽  
Stromal Tumors ◽  
Primary Gist ◽  
Metastatic Gist

Large single-institution series of patients undergoing resection for gastrointestinal stromal tumors (GIST) are lacking. Clinicopathologic characteristics and postoperative outcomes were retrospectively collected and analyzed from patients undergoing resection for GIST from 2002 to 2011. One hundred seventy-six patients were identified; 156 underwent resection of primary nonmetastatic disease. KIT mutations were identified in 131 patients (84.0%). Of the 156 patients with primary disease, the most common site was the stomach (75.6%). Tumors were categorized as very low (24.4%), low (35.9%), intermediate (12.2%), high (24.4%), or unknown (3.2%) risk. Symptomatic patients more often had high risk (35.6 vs 9.8%; P < 0.0001) and larger tumors (7.3 vs 3.0 cm; P < 0.0001). Forty-seven patients (30.1%) underwent laparoscopic resection (LR). Compared with open surgery, LR was performed for smaller tumors (3.8 vs 6.2 cm; P = 0.002). Positive margin rates were similar (4.3% LR vs 10.2% open; P = 0.346). Median follow-up for the 156 patients with primary tumors was 32.9 months; mean overall survival was 120.9 months (median not reached). Of the 20 patients with metastatic GIST (excluded from above analysis), five patients (25.0%) died of disease with a median follow-up of 15.9 months. Most patients with resectable primary GIST have a favorable prognosis. The presence of symptoms directly related to GIST may be associated with a poor prognosis and is likely related to increased tumor size. Laparoscopic resection is well tolerated and does not appear to compromise outcomes in well-selected patients. Highly selected patients with metastatic disease may benefit from resection.

Adjuvant Imatinib treatment after R0 resection for patients with high-risk gastrointestinal stromal tumors: A median follow-up of 44 months

2011 ◽  
Vol 104 (7) ◽  
pp. 760-764 ◽  
Author(s):  
Wei-Zhong Jiang ◽  
Guo-Xian Guan ◽  
Hui-Shan Lu ◽  
Ying-Hong Yang ◽  
De-Yong Kang ◽  
...  
Keyword(s):  
High Risk ◽  
Gastrointestinal Stromal Tumors ◽  
R0 Resection ◽  
Imatinib Treatment ◽  
Adjuvant Imatinib ◽  
Stromal Tumors

Residual and Recurrent Gastrointestinal Stromal Tumors WithKITMutations: Findings at First Follow-Up CT After Imatinib Treatment

2009 ◽  
Vol 193 (2) ◽  
pp. W100-W105 ◽  
Author(s):  
Dongil Choi ◽  
Eun Young Yoo ◽  
Kyoung-Mee Kim ◽  
Tae Sung Sohn ◽  
Won Jae Lee ◽  
...  
Keyword(s):  
Gastrointestinal Stromal Tumors ◽  
Imatinib Treatment ◽  
Stromal Tumors

scholarly journals Laparoscopic and Endoscopic Cooperative Dissection for Small Gastric Gastrointestinal Stromal Tumor without Causing Injury to the Mucosa

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Lei Cao ◽  
Kunming Zheng ◽  
Honglei Wang ◽  
Yongjie Zhao ◽  
Zhengduo Yang ◽  
...  
Keyword(s):  
Gastrointestinal Stromal Tumors ◽  
Postoperative Bleeding ◽  
Operation Time ◽  
Massive Bleeding ◽  
Intraoperative Bleeding ◽  
Stromal Tumors ◽  
Gastric Gists ◽  
Chemotherapy Drugs ◽  
Complete Tumor

Objective. To investigate the feasibility of laparoscopic and endoscopic cooperative dissection (LECD) for small gastric gastrointestinal stromal tumors (GISTs) without causing injury to the mucosa, compared with ESD surgery which is widely used now. Methods. A total of 25 patients with small gastric GISTs who underwent LECD and 20 patients with small gastric GISTs who underwent ESD between October 2014 and June 2016 were included in this study. All patients underwent curative resection for pathologically diagnosed small gastric GISTs. Patients’ clinical data were retrospectively analyzed. Results. In LECD group, the operation was successfully performed in all patients. However, in the ESD group, three patients were transferred to laparoscopic surgery due to intraoperative massive bleeding or intraoperative perforation. No additional targeted chemotherapy drugs for interstitial tumors were prescribed in two groups. There was no difference in the complete tumor capsule rate (100% vs. 90%, p=0.11), operation time (80.76±13.86 ml vs. 84.05±15.33 ml, p=0.45), major intraoperative bleeding (0 vs. 5%, p=0.26), postoperative bleeding (0 vs. 10%, p=0.11), and postoperative infection (0 vs. 10%, p=0.11) between the two groups. Compared to ESD (endoscopic submucosal dissection), LECS patients had shorter postoperative indwelling gastric tube (1.04±0.98 d vs. 2.85±0.24 d, p<0.01), earlier postoperative eating (1.96±0.98 d vs. 3.50±1.15 d, p<0.01), shorter average postoperative hospital stay (3.44±1.00 d vs. 7.85±1.18 d, p<0.01), smaller perforation rate (0 vs. 25%, p < 0.05), and fewer surgical supplies. No recurrence or metastasis cases were found between the two groups during the follow-up period, and there were no cases of death due to gastric GISTs. Conclusion. LECD is a novel surgery for small gastric gastrointestinal stromal tumors that leads to satisfactory short-term outcomes and meets the idea of minimally invasive surgery and rapid recovery; compared with ESD, LECD surgery has some advantages in clinical practice. However, further follow-up is needed to confirm.

Absorbable suture material in carotid surgery

VASA ◽  
2015 ◽  
Vol 44 (6) ◽  
pp. 451-457 ◽  
Author(s):  
Vincenzo Gasbarro ◽  
Luca Traina ◽  
Francesco Mascoli ◽  
Vincenzo Coscia ◽  
Gianluca Buffone ◽  
...  
Keyword(s):  
Suture Material ◽  
Absorbable Suture ◽  
Paediatric Surgery ◽  
Carotid Surgery ◽  
Suture Materials ◽  
Absorbable Suture Material ◽  
Absorbable Sutures ◽  
Group A ◽  
Group B

Abstract. Background: Absorbable sutures are not generally accepted by most vascular surgeons for the fear of breakage of the suture line and the risk of aneurysmal formation, except in cases of paediatric surgery or in case of infections. Aim of this study is to provide evidence of safety and efficacy of the use of absorbable suture materials in carotid surgery. Patients and methods: In an 11 year period, 1126 patients (659 male [58.5 %], 467 female [41.5 %], median age 72) underwent carotid endarterectomy for carotid stenosis by either conventional with primary closure (cCEA) or eversion (eCEA) techniques. Patients were randomised into two groups according to the type of suture material used. In Group A, absorbable suture material (polyglycolic acid) was used and in Group B non-absorbable suture material (polypropylene) was used. Primary end-point was to compare severe restenosis and aneurysmal formation rates between the two groups of patients. For statistical analysis only cases with a minimum period of follow-up of 12 months were considered. Results: A total of 868 surgical procedures were considered for data analysis. Median follow-up was 6 years (range 1-10 years). The rate of postoperative complications was better for group A for both cCEA and eCEA procedures: 3.5 % and 2.0 % for group A, respectively, and 11.8 % and 12.9 % for group B, respectively. Conclusions: In carotid surgery, the use of absorbable suture material seems to be safe and effective and with a general lower complications rate compared to the use of non-absorbable materials.

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