• Endoscopic resection
• Esophagogastric junction
• Gastrointestinal stromal tumor
• Laparoscopic resection
• Propensity score matching

• Humans
• Gastrointestinal Stromal Tumors/surgery
• Gastrointestinal Stromal Tumors/pathology
• Female
• Laparoscopy/methods
• Laparoscopy/adverse effects
• Male
• Esophagogastric Junction/surgery
• Esophagogastric Junction/pathology
• Middle Aged
• Propensity Score
• Aged
• Quality of Life
• Treatment Outcome
• Retrospective Studies
• Postoperative Complications
• Adult
• China
• Length of Stay

• Gastrointestinal stromal tumors
• Laparoscopic surgery
• Minimally invasive surgical procedures
• Natural orifice transluminal endoscopic surgery

• Humans
• Stomach Neoplasms/surgery
• Stomach Neoplasms/pathology
• Gastroscopy/methods
• Gastroscopy/trends
• Endoscopic Mucosal Resection/methods
• Endoscopic Mucosal Resection/trends
• Gastrointestinal Stromal Tumors/surgery
• Gastrointestinal Stromal Tumors/pathology
• Laparoscopy/methods

• endoscopic submucosal dissection
• endoscopic ultrasonography
• gastric
• leiomyosarcoma

• Humans
• Female
• Leiomyosarcoma/surgery
• Leiomyosarcoma/diagnosis
• Leiomyosarcoma/diagnostic imaging
• Aged
• Stomach Neoplasms/surgery
• Stomach Neoplasms/diagnosis
• Stomach Neoplasms/diagnostic imaging
• Endoscopic Mucosal Resection/methods
• Endosonography
• Treatment Outcome

• Gastric cancer
• LECS
• Minimally Invasive Surgery

• Karolinska Institute

• gastric deformity
• gastric submucosal tumor
• gastrointestinal stromal tumor
• laparoscopic endoscopic cooperative surgery

• Endoscopic therapy
• Gastrointestinal stromal tumors
• SEER database
• Surgical resection
• Survival

• Humans
• Gastrointestinal Stromal Tumors/surgery
• Gastrointestinal Stromal Tumors/pathology
• Gastrointestinal Stromal Tumors/mortality
• Male
• Female
• Middle Aged
• Retrospective Studies
• SEER Program
• Aged
• Stomach Neoplasms/surgery
• Stomach Neoplasms/pathology
• Stomach Neoplasms/mortality
• Propensity Score
• Survival Rate
• Gastrectomy/methods
• Treatment Outcome
• Proportional Hazards Models
• Adult
• Tumor Burden

• Endoscopic full-thickness resection
• Endoscopic resection
• Gastric subepithelial tumor
• NESS-EFTR
• Submucosal tunneling

• 2310780 National Cancer Center

• Ectopic pancreas
• Endoscopic submucosal dissection
• Endoscopic ultrasonography
• Laparoscopic resection

• Forward-Return Way
• common submucosal tumor
• gastric fundus
• gastrointestinal stromal tumor
• muscularis propria

• Endoscopic closure
• Endoscopic full-thickness resection
• Over-the-scope clip
• Purse-string suture

• Swine
• Animals
• Traction
• Stomach/surgery
• Endoscopy
• Sutures
• Suture Techniques

To investigate the safety, efficacy, and selection strategy of laparoscopic local gastrectomy for stromal tumors in the esophagogastric junction.

Thirty-eight patients with mesenchymal tumors in the esophagogastric junction were retrospectively enrolled from April 2018 to July 2021 in which the upper edge of the tumor is less than 2 cm from the Z-line or has invaded the Z-line <1/2 circumference. Surgical outcomes, complications, recover, and postoperative gastroesophageal reflux of both groups were compared.

27 patients underwent wedge resection, and 11 underwent resection by opening all of the layers of the stomach wall. Operative time (90.0 vs. 181.8 min, respectively, P = 0.001) was shorter for the WR group vs. RASW. Blood loss (20 vs. 50 ml, respectively, P = 0.012) was less for the WR group vs. RASW. Recovery of the RASW group was slower in terms of time to pass gas (2 vs. 3 days, P = 0.034), time to oral intake (2 vs. 4 days, P = 0.007), time to semi-liquid food intake (4 vs. 8 days, P = 0.003), and postoperative hospitalization (5 vs. 8 days, P = 0.001) vs. WR. In terms of short-term complications (≤30 days), no significant between-group differences were observed. Cardia stenosis did not occur in either group. In the WR group, one patient experienced mild reflux at 6 months and recovered 1 year after surgery. In the RASW group, one patient experienced severe gastroesophageal reflux at 6 months and 1 year after surgery, which was not entirely relieved by taking antacids. No other patients have gastroesophageal reflux.

Laparoscopic local gastrectomy is safe and feasible for mesenchymal tumors in the esophagogastric junction in which the upper edge of the tumor is less than 2 cm from the Z-line or has invaded the Z-line <1/2 circumference, and has achieved an excellent short-term effect. The choice of surgery is based on the relationship between the tumor and the position of the cardia.

• Beijing Municipal Administration of Hospitals Incubating Program
• Beijing Friendship Hospital, Capital Medical University
• Beijing Municipal Science / Technology Commission

• Endoscopic submucosal dissection
• Full-thickness resection of colorectal tumors
• Laparoscopic endoscopic cooperative surgery
• Robotic and endoscopic cooperative colorectal surgery
• Robotic endoscopic cooperative surgery
• Robotic surgery

• Animals
• Colorectal Neoplasms/surgery
• Feasibility Studies
• Female
• Laparoscopy/methods
• Robotic Surgical Procedures
• Swine
• Treatment Outcome

• Gastrointestinal stromal tumors
• endoscopic submucosal resection preserving serosa
• integrity of gastric serosa

• gastrointestinal stromal tumors in esophagogastric junction
• laparoscopic surgery
• logistic regression
• nomogram
• resection of cardiac structure

• Guangdong Provincial Hospital of Traditional Chinese Medicine

The aim of this study was to analyze patients who underwent endoscopic resection (ER) for gastric subepithelial tumors (SETs) with a high probability of surgical intervention. Between January 2013 and January 2021, 83 patients underwent ER at the operation theater and 27 patients (32.5%) required backup surgery mainly due to incidental perforation or uncontrolled bleeding despite endoscopic repairing. The tumor was predominantly located in the upper-third stomach (81%) with a size ≤ 2 cm (69.9%) and deep to the muscularis propria (MP) layer (92.8%) but there were no significant differences between two groups except tumor exophytic growth as a risk factor in the surgery group (37% vs. 0%, p < 0.0001). Patients in the ER-only group had shorter durations of procedure times (60 min vs. 185 min, p < 0.0001) and lengths of stay (5 days vs. 7 days, p < 0.0001) but with a higher percentage of overall morbidity graded III (0% vs. 7.1%, p = 0.1571). After ER, five patients (6%) had delayed perforation and two (2.4%) required emergent laparoscopic surgery. Neither recurrence nor gastric stenosis was reported during long-term surveillance. Here, we provide a minimally invasive strategy of endoscopic resection with backup laparoscopic surgery for gastric SETs.

• delayed perforation
• endoscopic resection
• gastric subepithelial tumor
• gastrointestinal stromal tumor
• laparoscopic surgery

• GISTs
• gastric resection
• gastrointestinal stromal tumor
• intracorporeal suture
• laparoscopic surgery
• minimally invasive surgery
• robotic surgery

• cervical esophagus
• endoscopic resection
• esophagectomy
• larynx-preserving surgery
• squamous cell carcinoma

Leiomyosarcoma is a rare tumor that could originate from the gastrointestinal tract, uterus, kidney, retroperitoneum, and the soft tissues of the extremities. It accounts for only 1% of all gastrointestinal mesenchymal tumors and primary leiomyosarcoma of the stomach is extremely rare. Most cases reported as leiomyosarcoma of the stomach before the development of KIT immunohistochemistry might be gastrointestinal stromal tumors (GISTs) of the stomach and only 18 cases of leiomyosarcoma of the stomach have been reported since early 2000s. We report here a patient with leiomyosarcoma of the stomach treated by laparoscopic and endoscopic cooperative surgery (LECS).

A 59-year-old man was referred to our hospital for an early gastric cancer, which was initially treated by endoscopic submucosal dissection. Six months after his initial treatment, a follow-up esophagogastroduodenoscopy revealed a small polypoid lesion at the lesser curvature of the proximal stomach, which appeared to be a hyperplastic polyp. However, one and a half years later, the lesion grew and showed more irregular surface. Biopsy at the time revealed smooth muscle cell proliferation suggestive of leiomyoma. Three years later, the lesion grew even larger and biopsy showed pleomorphic spindle cells. Immunohistochemical study showed positive staining for alpha-smooth muscle actin and desmin, but negative for c-kit and CD34. Ki-67 labeling index was nearly 60%. Based on these findings, the diagnosis of leiomyosarcoma was established. The patient subsequently underwent a partial gastrectomy by LECS. The patient is currently in good condition without recurrence or metastasis at 12 months after surgery.

Leiomyosarcoma of the stomach is extremely rare. This is the first report of leiomyosarcoma of the stomach treated by LECS. We could also follow its appearance change through endoscopic examination for 3 years.

• Case report
• Gastrointestinal stromal tumor
• Laparoscopic and endoscopic cooperative surgery
• Leiomyosarcoma of the stomach
• Mesenchymal tumor
• Submucosal tumor

Nonexposure simple suturing endoscopic full-thickness resection (NESS-EFTR) is a recently developed method to prevent the exposure of tumor cells, and we performed a small prospective trial of NESS-EFTR for gastric subepithelial tumors (SETs). In this study, we compared the results of NESS-EFTR trial with those of another small prospective trial of laparoscopic and endoscopic cooperative surgery which was performed in different time period. The results of this study show the feasibility of NESS-EFTR for gastric SETs and provide evidence for the clinical application of the NESS-EFTR procedure.

Recently, nonexposure simple suturing endoscopic full-thickness resection (NESS-EFTR) method was developed to avoid tumor exposure to the peritoneal cavity. The aim of this study is to compare the short-term outcomes of the NESS-EFTR method with those of laparoscopic and endoscopic cooperative surgery (LECS) for gastric subepithelial tumors (SETs). A prospective single-center trial of LECS for gastric SETs was performed from March 2012 to October 2013 with a separate prospective trial of NESS-EFTR performed from August 2015 to June 2017, enrolling 15 patients each. Among the 30 enrolled patients, 14 who underwent LECS and 11 who underwent NESS-EFTR were finally included in the analysis. The rate of complete resection and successful closure was 100% in both groups. The operating time was longer for NESS-EFTR group than for LECS (110 vs. 189 min; p < 0.0001). There were no postoperative complications except one case of transient fever in the NESS-EFTR group. One patient in the LECS group had peritoneal seeding of gastrointestinal stromal tumor at 17 months postoperatively, and there was no other recurrence. Although NESS-EFTR had long operating and procedure times, it was feasible for patients with gastric SETs requiring a nonexposure technique.

• early gastric cancer
• endoscopic full-thickness resection
• laparoscopic and endoscopic cooperative surgery
• nonexposure technique

• conversion surgery
• esophagogastric junction
• laparoscopic and endoscopic cooperative surgery

• Gastric submucosal tumor
• Gastrointestinal stromal tumor
• Laparoscopic ultrasound
• Laparoscopic wedge resection

• Gastrectomy
• Gastrointestinal Stromal Tumors/diagnostic imaging
• Gastrointestinal Stromal Tumors/surgery
• Humans
• Laparoscopy
• Stomach Neoplasms/diagnostic imaging
• Stomach Neoplasms/surgery
• Ultrasonography, Interventional

Third space robotic and endoscopic cooperative surgery (TS-RECS) is a novel minimally invasive surgery for resecting gastric submucosal tumours (GSMTs), which could accomplish the completely oncological curability and maximal functional preservation. This study investigated the clinical outcomes and gastrointestinal function after TS-RECS versus laparoscopic wedge resection (LWR) for GSMTs. This was a single-centre retrospective study that included 130 patients with GSMTs who underwent LWR or TS-RECS from 2013 to 2019. To overcome selection biases, we performed propensity score matching (1:1) using seven covariates that could impact the group assignment and outcomes. Then, the clinical outcomes and gastrointestinal function in the LWR and TS-RECS groups were compared in a matched cohort. Among the 130 enrolled patients, 96 patients underwent LWR, and 34 underwent TS-RECS and were matched into 30 patients for each group. There was no significant difference in the operation time between the two groups (P = 0.543). However, the TS-RECS group had significantly less blood loss (20,5–100 vs 95,10–310 ml, P < 0.0001) and better postoperative recovery in terms of time to oral intake (2,2–4 vs 3,2–6 days, P < 0.0001) and postoperative hospital stay (5,4–10 vs 8.5,5–16 days, P < 0.0001) than the LWR group. The severity and frequency scores of postoperative gastrointestinal symptoms in the TS-RECS group were significantly lower than those in the LWR group. The median follow-up period was 24 months (10–60 months) in the LWR group and 18 months (10–27 months) in the TS-RECS group, and there was in total a single recurrence in the LWR group. TS-RECS appears to be a technically safe and effective surgery with preservation of gastrointestinal function for resection of GSMT resection.

• Clinical outcomes
• Gastrointestinal function
• Gastrointestinal submucosal tumours
• Laparoscopic wedge resection
• Third space robotic and endoscopic cooperative surgery

• clinical trial
• phase III
• precision medicine
• sentinel lymph node
• stomach neoplasms

• Endpoint Determination
• Female
• Follow-Up Studies
• Humans
• Lymph Node Excision
• Male
• Neoplasm Recurrence, Local/pathology
• Prospective Studies
• Quality of Life
• Sentinel Lymph Node/pathology
• Sentinel Lymph Node/surgery
• Sentinel Lymph Node Biopsy
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery

Laparoscopic resection is increasingly performed for gastrointestinal stromal tumors (GISTs). However, the laparoscopic approach for GISTs located in the esophagogastric junction (EGJ-GIST) is surgically challenging. This study compares the efficacy of laparoscopic surgery and the open procedure for EGJ-GIST through the propensity score weighting (PSW) method.

Between April 2006 and April 2018, 1,824 surgical patients were diagnosed with primary gastric GIST at four medical centers in South China. Of these patients, 228 were identified as EGJ-GISTs and retrospectively reviewed clinicopathological characteristics, operative information, and long-term outcomes. PSW was used to create the balanced cohorts.

PSW was carried out in laparoscopic and open-surgery cohorts according to year of surgery, sex, age, body mass index (BMI), tumor size, mitotic rates and recurrence risk. After PSW, 438 patients consisting of 213 laparoscopic (L group) and 225 open surgery (O group) patients were enrolled. After PSW, the following measures in the L group were superior to those in the O group: median operative time [interquartile range (IQR)]: 100.0 (64.5−141.5)vs. 149.0 (104.0−197.5) min, P<0.001; median blood loss (IQR): 30.0 (10.0−50.0)vs. 50.0 (20.0−100.0) mL, P=0.002; median time to liquid intake (IQR): 3.0 (2.0−4.0)vs. 4.0 (3.0−5.0) d, P<0.001; median hospital stay (IQR): 6.0 (4.0−8.0)vs. 7.0 (5.0−12.0) d, P<0.001; and postoperative complications (10.3%vs. 22.7%, P=0.001). The median follow-up was 55 (range, 2−153) months in the entire cohort. No significant differences were detected in either relapse-free survival (RFS) [hazard ratio (HR): 0.372, 95% confidence interval (95% CI): 0.072−1.910, P=0.236) or overall survival (OS) (HR: 0.400, 95% CI: 0.119−1.343, P=0.138) between the two groups.

Laparoscopic surgery for EGJ-GIST is associated with the advantages of shorter operative time, reduced blood loss, shorter time to liquid intake, and shorter length of stay, all without compromising postoperative outcomes and long-term survival.

• Esophagogastric junction
• gastrointestinal stromal tumor
• laparoscopic surgery
• open surgery
• propensity score weighting

• Esophagogastric junction
• Fundoplication
• Laparoscopic and endoscopic cooperative surgery
• Submucosal tumor

•

Gastric adenocarcinoma arising from a leiomyoma which is diagnosed by pathological evidence as heterotopic glands carcinoma within it.

We experienced an extremely rare case of gastric adenocarcinoma wrapped by leiomyoma.

A 65-year-old man had an abnormality (filling defect) of the upper gastrointestinal series in his first medical checkup five years prior. Esophagogastroduodenoscopy detected a 10 mm submucosal tumor-like lesion in the greater curvature of the upper gastric remnant body. Despite repeated biopsy from the lesion, there was no sign of malignancy. A delle was observed on the top of the tumor at another visit five year after the first and a biopsy specimen revealed poorly differentiated adenocarcinoma. Therefore, laparoscopic gastrectomy was performed. Histological assessment revealed a 28 × 22 mm elevated lesion with a slight depression. Microscopically, papillary adenocarcinoma was observed at the submucosa with a solitary heterotopic gastric gland adjacent to the lesion. The final diagnosis was papillary adenocarcinoma arising from a solitary heterotopic gastric gland in the leiomyoma. No recurrence has occurred during a follow-up of two and a half years after surgery.

This is the first report of gastric adenocarcinoma arising from a submucosal tumor.

• Adenocarcinoma in leiomyoma
• Solitary heterotopic gastric gland

• Gastric remnant function
• Gastric submucosal tumors
• Laparoscopic endoscopic co-operative surgery

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.

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.

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.

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.

Surgical management of gastric gastrointestinal stromal tumors (GISTs) has evolved towards minimal invasiveness. Laparoscopic wedge resection and laparoscopic and endoscopic cooperative surgery had been considered as standard surgical treatments for gastric GISTs > 2 cm. However, stomach deformation and the full-thickness gastric defect caused by these procedures may increase the risk of morbidity. To address these problems, we developed a novel technique, third space robotic and endoscopic cooperative surgery (TS-RECS), which could dissect the tumor entirely while preserving the intact mucosal layer. Here we performed a prospective evaluation of the feasibility and safety of TS-RECS.

Patients with gastric GISTs were recruited between April 2018 and April 2019. During the operation, the gastric GIST was located by endoscopic view firstly and the submucosal injection was performed. The tumor was then dissected through robotic surgery. Clinicopathological characteristics, operative data, adverse events, and follow-ups were prospectively collected and analyzed.

A total of 20 patients with gastric GISTs received TS-RECS. The mean tumor size was 33.0 ± 7.3 mm. R0 resection was achieved in all patients with a median operation time of 115 min and a median blood loss of 20 ml. The integrity of mucosal layer was maintained in 95% (19/20) of the patients. All patients started oral diet on postoperative day 1 or 2, staying in the hospital for a median of 6 days after surgery. There were no major adverse events. Local or distant recurrences were not observed during a median follow-up period of 10 months.

Our study suggests that TS-RECS appears to be a feasible and safe technique which could be an alternative method for resecting gastric GISTs > 2 cm.

ClinicalTrials.gov NCT03804762.

The online version of this article (10.1007/s00464-019-07223-w) contains supplementary material, which is available to authorized users.

• Endoscopic technique
• Gastric submucosal tumors
• Gastrointestinal stromal tumors
• Robotic surgery
• Submucosal injection
• The third space

• Laparoscopic and endoscopic cooperative surgery (LECS)
• combination of laparoscopic and endoscopic approaches for neoplasia with non-exposure technique (CLEAN-NET)
• gastric submucosal tumors (SMTs)
• non-exposed endoscopic wall-inversion surgery (NEWS)

• gastric cancer
• lymph node metastasis
• prediction

• Early gastric cancer
• Facility-based
• Gastrointestinal stromal tumor
• Laparoscopic and endoscopic cooperative surgery
• Minimally invasive surgery

Gastrointestinal stromal tumors (GIST) typically appear as solid masses, and cystic formation is uncommon. Most stomach GISTs with cystic formation progress outside the gastric wall and are frequently misdiagnosed as epigastric cystic tumors derived from pancreas or liver. An asymptomatic 72-year-old male underwent esophagogastroduodenoscopy, which revealed a submucosal tumor (SMT), approximately 50 mm in diameter, at the anterior wall of the gastric angle. The SMT was very soft with positive cushion sign. Endoscopic ultrasonography and contrast-enhanced computed tomography revealed that the SMT was a cystic tumor with solid component. Laparoscopic and endoscopic cooperative surgery were performed to remove the tumor. Histopathological analysis revealed that the tumor was a GIST with cystic formation. To the best of our knowledge, this the first documented case of a cushion sign-positive stomach GIST with cystic formation, which had mainly developed inside the stomach. This case suggests that we should keep in mind the possibility of cystic formation of GIST when the tumor has a solid component, even if it appears as a cushion sign-positive SMT.

• cushion sign
• cystic formation
• gastrointestinal stromal tumor

• endoscopic full-thickness resection
• endoscopic resection
• gastric submucosal tumor
• laparoscopic endoscopic cooperative surgery (LECS)
• laparoscopic resection

• Endoscopic assistance
• Esophagogastric junction
• Gastric submucosal tumor
• Laparoscopic wedge resection

• Adult
• Aged
• Endoscopy, Gastrointestinal
• Esophagogastric Junction/surgery
• Feasibility Studies
• Female
• Gastric Mucosa/pathology
• Gastric Mucosa/surgery
• Gastrointestinal Stromal Tumors/surgery
• Humans
• Laparoscopy
• Male
• Middle Aged
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Treatment Outcome