Brief Article
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World J Gastroenterol. Sep 14, 2013; 19(34): 5720-5726
Published online Sep 14, 2013. doi: 10.3748/wjg.v19.i34.5720
Laparoscopic-endoscopic cooperative surgery for gastric submucosal tumors
Wei-Ming Kang, Jian-Chun Yu, Zhi-Qiang Ma, Zi-Ran Zhao, Qing-Bin Meng, Xin Ye
Wei-Ming Kang, Jian-Chun Yu, Zhi-Qiang Ma, Zi-Ran Zhao, Qing-Bin Meng, Xin Ye, Department of General Surgery, Peking Union Medical College Hospital, CAMS and PUMC, Beijing 100730, China
Author contributions: Yu JC, Kang WM and Ma ZQ designed the study, wrote the manuscript, performed the operations and supervised the research; Zhao ZR, Ye X and Meng QB collected the clinical data and followed up the patients.
Supported by Wu Jieping Medical Foundation Special Grant for Clinical Research, No. 320.6752.1206; Beijing Municipal Natural Science Foundation of China, No. 7132209; and the Innovation Fund from Chinese Academy of Medical Sciences and Peking Union Medical College, No. 2011-1002-017
Correspondence to: Jian-Chun Yu, MD, Department of General Surgery, Peking Union Medical College Hospital, CAMS and PUMC, No. 1 Shuai Fu Yuan, Dongcheng District, Beijing 100730, China. yu-jch@163.com
Telephone: +86-10-69152215 Fax: +86-10-69152215
Received: June 17, 2013
Revised: August 6, 2013
Accepted: August 8, 2013
Published online: September 14, 2013
Abstract

AIM: To assess the feasibility, safety, and advantages of minimally invasive laparoscopic-endoscopic cooperative surgery (LECS) for gastric submucosal tumors (SMT).

METHODS: We retrospectively analyzed 101 consecutive patients, who had undergone partial, proximal, or distal gastrectomy using LECS for gastric SMT at Peking Union Medical College Hospital from June 2006 to April 2013. All patients were followed up by visit or telephone. Clinical data, surgical approach, pathological features such as the size, location, and pathological type of each tumor; and follow-up results were analyzed. The feasibility, safety and effectiveness of LECS for gastric SMT were evaluated, especially for patients with tumors located near the cardia or pylorus.

RESULTS: The 101 patients included 43 (42.6%) men and 58 (57.4%) women, with mean age of 51.2 ± 13.1 years (range, 14-76 years). The most common symptom was belching. Almost all (n = 97) patients underwent surgery with preservation of the cardia and pylorus, with the other four patients undergoing proximal or distal gastrectomy. The mean distance from the lesion to the cardia or pylorus was 3.4 ± 1.3 cm, and the minimum distance from the tumor edge to the cardia was 1.5 cm. Tumor pathology included gastrointestinal stromal tumor in 78 patients, leiomyoma in 13, carcinoid tumors in three, ectopic pancreas in three, lipoma in two, glomus tumor in one, and inflammatory pseudotumor in one. Tumor size ranged from 1 to 8.2 cm, with 65 (64.4%) lesions < 2 cm, 32 (31.7%) > 2 cm, and four > 5 cm. Sixty-six lesions (65.3%) were located in the fundus, 21 (20.8%) in the body, 10 (9.9%) in the antrum, three (3.0%) in the cardia, and one (1.0%) in the pylorus. During a median follow-up of 28 mo (range, 1-69 mo), none of these patients experienced recurrence or metastasis. The three patients who underwent proximal gastrectomy experienced symptoms of regurgitation and belching.

CONCLUSION: Laparoscopic-endoscopic cooperative surgery is feasible and safe for patients with gastric submucosal tumor. Endoscopic intraoperative localization and support can help preserve the cardia and pylorus during surgery.

Keywords: Laparoscopic-endoscopic cooperative surgery, Gastric submucosal tumor, Minimally invasive surgery, Laparoscopy, Endoscopy

Core tip: We retrospectively analyzed 101 consecutive patients who had undergone partial, proximal or distal gastrectomy using laparoscopic-endoscopic cooperative surgery (LECS) for gastric gastric submucosal tumor (SMT) at Peking Union Medical College Hospital from June 2006 to April 2013. Ninety-seven patients underwent surgery with preservation of the cardia and pylorus, with the other four patients undergoing proximal or distal gastrectomy. LECS is feasible and safe for gastric SMT, especially for patients with tumors near the cardia or pylorus. Intraoperative localization and support by endoscopy can help preserve the cardia and pylorus during surgery.