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Chen LQ, Wu CY, Wu SJ, Ye K. Laparoscopic surgical approaches for various locations of gastrointestinal stromal tumours. World J Clin Cases 2025; 13:105559. [DOI: 10.12998/wjcc.v13.i21.105559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2025] [Revised: 03/18/2025] [Accepted: 04/01/2025] [Indexed: 04/27/2025] Open
Abstract
Gastrointestinal stromal tumours (GISTs) are tumours that originate from mesenchymal tissue, are predominantly located in the stomach, and typically do not metastasize to the lymph nodes. Surgical intervention remains the primary treatment modality for GISTs. Historically, open surgery was the predominant approach; however, advancements in medical technology have led to laparoscopic surgery becoming the standard practice. Compared with traditional open surgical techniques, laparoscopic surgery is less invasive and facilitates more rapid postoperative recovery. Given that GISTs can arise at any location within the gastrointestinal tract, the specific surgical methods employed vary according to both the tumour's anatomical site and its growth characteristics. The aim of this review is to examine laparoscopic surgical strategies for managing GISTs across different regions of the gastrointestinal tract by synthesizing recent research trends and relevant evidence-based medical literature.
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Affiliation(s)
- Li-Quan Chen
- Department of Colorectal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Chu-Ying Wu
- Department of Colorectal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Si-Jia Wu
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Kai Ye
- Department of Colorectal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
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Kitakata H, Itoh T, Kinami S, Hata Y, Kunou H, Mukai T, Shimasaki T. Sealed endoscopic full-thickness resection with sentinel node navigation for early gastric cancer without endoscopic submucosal dissection indication. Endosc Int Open 2025; 13:a25209882. [PMID: 40309062 PMCID: PMC12042990 DOI: 10.1055/a-2520-9882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 12/17/2024] [Indexed: 05/02/2025] Open
Abstract
Background and study aims Laparoscopic and endoscopic cooperative surgery (LECS) is a beneficial procedure that enables minimal resection of the gastric wall because the tumor can be located endoscopically. However, it is not indicated for epithelial tumors because of risk of peritoneal dissemination. Therefore, we devised a new LECS technique, known as sealed endoscopic full-thickness resection (sealed EFTR), in which the serosa was sealed with a silicone sheet to prevent escape of gastric contents and tumor cells. The aims of this study were to evaluate the safety and feasibility of a newly developed procedure and to observe its long-term outcomes, including absence of local recurrence and peritoneal dissemination. Patients and methods Approval was obtained from the Ethics Review Committee of the Japan Consortium for Advanced Surgical Endoscopy Study Group. Between December 2011 and July 2021, at Kanazawa Medical University Hospital, 16 patients with cT1 gastric cancer were enrolled in this study. Sealed EFTR was performed in patients diagnosed with negative lymph node metastasis via intraoperative sentinel node biopsy. Results Among the 16 enrolled patients, 12 (75%) had negative sentinel node metastases, 11 of whom underwent sealed EFTR. Except for two patients who died from other causes, no instances of metastasis or recurrence were observed during the mean follow-up period of 6.5 years (range, 2-11). Conclusions This study suggests that appropriate case selection for sentinel lymph node biopsy could allow for oncologically safe and individualized minimally invasive surgery for early gastric cancer that is ineligible for endoscopic submucosal dissection.
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Affiliation(s)
- Hidekazu Kitakata
- Gastroenterological Endoscopy, Kanazawa Medical University, Kahoku-gun, Japan
| | - Tohru Itoh
- Gastroenterological Endoscopy, Kanazawa Medical University, Kahoku-gun, Japan
| | - Shinichi Kinami
- Surgical Oncology, Kanazawa Medical University, Kahoku-gun, Japan
| | - Yoshiyuki Hata
- Gastroenterological Endoscopy, Kanazawa Medical University, Kahoku-gun, Japan
| | - Hiroaki Kunou
- Gastroenterological Endoscopy, Kanazawa Medical University, Kahoku-gun, Japan
| | - Tsuyoshi Mukai
- Gastroenterological Endoscopy, Kanazawa Medical University, Kahoku-gun, Japan
| | - Takeo Shimasaki
- Medical Research Institute, Kanazawa Medical University, Kahoku-gun, Japan
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Tanaka I, Shimamura Y, Inoue H, Azuma D, Ushikubo K, Yamamoto K, Okada H, Nishikawa Y, Tanabe M, Onimaru M. Endoscopic resection for gastric submucosal tumors: A single-center experience in Japan. DEN OPEN 2025; 5:e402. [PMID: 39011512 PMCID: PMC11249007 DOI: 10.1002/deo2.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/22/2024] [Accepted: 06/21/2024] [Indexed: 07/17/2024]
Abstract
Objectives Endoscopic resection (ER) for gastric submucosal tumors (SMTs) has gained prominence in recent years, with studies emerging from various countries. However, there is a paucity of reports from Japan. We aimed to elucidate the efficacy and safety of ER for gastric SMT in Japan. Methods In this retrospective observational study, we investigated the outcomes of consecutive patients who underwent ER for gastric SMT from January 2017 to May 2023. The outcome variables assessed included the complete resection rate, procedure time, closure-related outcomes, and the incidence of adverse events. Results A total of 13 patients were included in the analysis. The median procedure time was 163 (55-283) min. Complete full-thickness resection was performed in seven cases, while in four cases, the serosa remained, and in two cases, the outer layer of the muscularis propria remained. In two cases where the SMT was located on the anterior side, conversion to laparoscopic surgery became necessary, resulting in a procedural success rate of 84.6% (11/13). Excluding these two cases, endoscopic closure of the defect was successfully accomplished in the remaining 11 cases. R0 resection was achieved in 12 out of 13 cases (92.3%). Although one patient had peritonitis, which was successfully treated conservatively, no other treatment-related adverse events were encountered. Conclusions Although ER for SMT on the anterior side may be challenging, our experience revealed that ER is a safe and efficacious approach for gastric SMT.
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Affiliation(s)
- Ippei Tanaka
- Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
| | - Yuto Shimamura
- Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
| | - Haruhiro Inoue
- Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
| | - Daisuke Azuma
- Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
| | - Kei Ushikubo
- Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
| | - Kazuki Yamamoto
- Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
| | - Hiroki Okada
- Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
| | - Yohei Nishikawa
- Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
| | - Mayo Tanabe
- Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
| | - Manabu Onimaru
- Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
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Abe T, Toya Y, Sugai K, Komai M, Yanai S, Nikai H, Baba S, Sugimoto R, Yanagawa N, Matsumoto T. Non-exposed endoscopic wall-inversion surgery for an early gastric cancer arising from heterotopic submucosal gastric glands: A case report. DEN OPEN 2025; 5:e70097. [PMID: 40070931 PMCID: PMC11894265 DOI: 10.1002/deo2.70097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2025] [Revised: 02/27/2025] [Accepted: 03/03/2025] [Indexed: 03/14/2025]
Abstract
A 74-year-old man, who was scheduled for surgery against the main duct-type intraductal papillary mucinous neoplasm of the pancreas, was found to have a subepithelial lesion of the stomach under esophagogastroduodenoscopy. Endoscopic ultrasound-guided fine needle aspiration for the gastric lesion revealed adenocarcinoma cells. We thus considered carcinomas arising from heterotopic submucosal gastric glands and metastases from the pancreatic lesion as differential diagnoses. We first non-exposed endoscopic wall-inversion surgery to the lesion as a total biopsy. The gastric lesion was diagnosed as early gastric cancer originating from heterotopic submucosal gastric glands. The patient subsequently underwent a pylorus-preserving pancreatoduodenectomy for the intraductal papillary mucinous neoplasm. Our experience suggests non-exposed endoscopic wall-inversion surgery is a useful and minimally invasive option for the diagnosis and treatment of gastric submucosal lesions, which are presumed to be malignant in nature.
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Affiliation(s)
- Takeshi Abe
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineSchool of MedicineIwate Medical UniversityIwateJapan
| | - Yosuke Toya
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineSchool of MedicineIwate Medical UniversityIwateJapan
| | - Kyohei Sugai
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineSchool of MedicineIwate Medical UniversityIwateJapan
| | - Mizuki Komai
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineSchool of MedicineIwate Medical UniversityIwateJapan
| | - Shunichi Yanai
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineSchool of MedicineIwate Medical UniversityIwateJapan
| | - Haruka Nikai
- Department of SurgerySchool of MedicineIwate Medical UniversityIwateJapan
| | - Shigeaki Baba
- Department of SurgerySchool of MedicineIwate Medical UniversityIwateJapan
| | - Ryo Sugimoto
- Department of Molecular Diagnostic PathologySchool of MedicineIwate Medical UniversityIwateJapan
| | - Naoki Yanagawa
- Department of Molecular Diagnostic PathologySchool of MedicineIwate Medical UniversityIwateJapan
| | - Takayuki Matsumoto
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineSchool of MedicineIwate Medical UniversityIwateJapan
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Goto O, Higuchi K, Koizumi E, Iwakiri K. Advancements in Endoscopic Treatment for Gastric Subepithelial Tumors. Gut Liver 2025; 19:151-160. [PMID: 39774123 PMCID: PMC11907253 DOI: 10.5009/gnl240358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Revised: 10/08/2024] [Accepted: 10/16/2024] [Indexed: 01/11/2025] Open
Abstract
Peroral flexible endoscopy is a minimally invasive technique that enables the local resection of gastric subepithelial tumors (SETs) with malignant potential. Resection techniques are mainly chosen on the basis of the lesion size. Minute SETs less than 1 cm should be managed through a watch and wait strategy, with the exception of histologically diagnosed superficial lesions, which require endoscopic mucosal resection or endoscopic submucosal dissection. For 1- to 3-cm small SETs, endoscopic enucleation techniques, such as endoscopic submucosal excavation, submucosal tunneling endoscopic resection, and peroral endoscopic tumor resection, can be used. However, endoscopic full-thickness resection is preferred for histologically complete removal with negative surgical margins. When endoscopic full-thickness resection is considered technically difficult, laparoscopic and endoscopic cooperative surgery (LECS) is a safe and dependable alternative. Moderate-sized SETs (3 to 5 cm) require surgical intervention because the lesions must be removed transabdominally. LECS is a less invasive surgical procedure as it reduces the resection area; however, some LECS techniques that require transoral tumor retrieval are not available. Endoscopic intervention for lesions larger than 5 cm should be used with caution for research purposes. With advancements in endoscopic diagnosis, the indications for endoscopic treatment for SETs are expected to improve, thereby enhancing patients' quality of life.
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Affiliation(s)
- Osamu Goto
- Department of Gastroenterology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
- Endoscopy Center, Nippon Medical School Hospital, Tokyo, Japan
| | - Kazutoshi Higuchi
- Department of Gastroenterology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Eriko Koizumi
- Department of Gastroenterology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Katsuhiko Iwakiri
- Department of Gastroenterology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
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Otowa Y, Kawara F, Takiguchi G, Yamanaka K, Goto T, Nishioka C, Kuroda D, Ku Y. Treatment strategy and clinical outcomes of thoracoscopic endoscopic cooperative surgery for submucosal tumors in the esophagus. Surg Today 2025:10.1007/s00595-025-03003-3. [PMID: 40019506 DOI: 10.1007/s00595-025-03003-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Accepted: 12/25/2024] [Indexed: 03/01/2025]
Abstract
PURPOSE Recently, submucosal tumors (SMTs) of the esophagus have been treated with peroral endoscopic tumor resection (POET) and a new procedure called thoracoscopic endoscopic cooperative surgery (TECS). This study aimed to validate the treatment strategy for SMTs and determine whether or not TECS is a viable option when POET is not feasible. METHODS POET and TECS were performed in 12 patients between February 2020 and January 2024. The clinical characteristics and perioperative outcomes were retrospectively evaluated. RESULTS Six patients were included in each group, with most of the tumors located in the middle thoracic esophagus (75%). The general anesthesia duration was significantly longer in the TECS group than in the POET group (P < 0.001), but no significant differences in endoscopic procedure time, tumor mass index, oral intake date, or length of hospital stay were observed between the two groups. En bloc and R0 resections were performed in all patients. One patient in the TECS group experienced a Clavien-Dindo grade 3a adverse event, and no tumor recurrence occurred during the median follow-up period of 33 (range, 6-53) months. CONCLUSION TECS is a safe and feasible option for SMTs when POET is difficult to perform.
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Affiliation(s)
- Yasunori Otowa
- Department of Gastrointestinal Surgery, Konan Medical Center, 1-5-16 Kamokogahara, Higashinada Ward, Kobe, 658-0064, Japan
| | - Fumiaki Kawara
- Department of Gastroenterology, Konan Medical Center, Kobe, Japan.
| | - Gosuke Takiguchi
- Department of Gastrointestinal Surgery, Konan Medical Center, 1-5-16 Kamokogahara, Higashinada Ward, Kobe, 658-0064, Japan
- Takiguchi Clinic, Kobe, Japan
| | - Kodai Yamanaka
- Department of Gastroenterology, Konan Medical Center, Kobe, Japan
| | - Tadahiro Goto
- Department of Gastrointestinal Surgery, Konan Medical Center, 1-5-16 Kamokogahara, Higashinada Ward, Kobe, 658-0064, Japan
| | - Chiharu Nishioka
- Department of Gastroenterology, Konan Medical Center, Kobe, Japan
| | - Daisuke Kuroda
- Department of Gastrointestinal Surgery, Konan Medical Center, 1-5-16 Kamokogahara, Higashinada Ward, Kobe, 658-0064, Japan
| | - Yonson Ku
- Department of Gastrointestinal Surgery, Konan Medical Center, 1-5-16 Kamokogahara, Higashinada Ward, Kobe, 658-0064, Japan
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Arahata K, Takarabe S, Nakamura K, Fujikawa Y, Katayama T, Ojiro K, Kishikawa H, Sasaki A, Hasegawa H, Nishida J. A case of gastric granular cell tumor successfully treated by laparoscopic and endoscopic cooperative surgery. Clin J Gastroenterol 2025; 18:62-66. [PMID: 39576493 DOI: 10.1007/s12328-024-02065-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 11/11/2024] [Indexed: 02/01/2025]
Abstract
We describe a case of gastric granular cell tumor (GCT) treated with laparoscopic and endoscopic cooperative surgery (LECS). A 30-year-old male was referred to our hospital for the investigation of a subepithelial lesion (SEL). Contrast-enhanced computed tomography and esophagogastroduodenoscopy revealed a 15 mm SEL within the posterior wall of the gastric body. Endoscopic ultrasound revealed a well-demarcated, homogenous, hypoechoic lesion in the submucosa, suggesting partial invasion into the muscularis propria. Biopsy using the bite-on-bite technique showed a gastric GCT diagnosis. The patient underwent LECS, and pathological findings confirmed a benign gastric GCT without muscularis propria invasion, lymphovascular invasion, or lymph node metastasis. The patient remained recurrence-free after 24 months.Despite unresolved issues such as setting the resection margins; indications for resection, and accurate preoperative diagnosis of the invasion depth, including muscularis propria invasion, LECS may be useful for gastric GCT in the form of SEL, especially for lesions that cannot be ruled out to invade the muscularis propria invasion.
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Affiliation(s)
- Kyoko Arahata
- Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Sakiko Takarabe
- Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Kenji Nakamura
- Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan.
| | - Yasue Fujikawa
- Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Tadashi Katayama
- Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Keisuke Ojiro
- Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Hiroshi Kishikawa
- Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Aya Sasaki
- Department of Clinical Laboratory, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | - Hirotoshi Hasegawa
- Department of Surgery, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | - Jiro Nishida
- Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan
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Maltzman H, Omae M, Klevebro F, Baldaque-Silva F, Rouvelas I. Laparoscopic and Endoscopic cooperative surgery as Rescue-treatment for Advanced gastric Cancer in patients Unfit for Surgery (LE-RACUS): protocol for a feasibility study. Pilot Feasibility Stud 2025; 11:1. [PMID: 39754254 PMCID: PMC11697475 DOI: 10.1186/s40814-024-01584-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 12/24/2024] [Indexed: 01/06/2025] Open
Abstract
BACKGROUND The standard treatment for advanced gastric cancer without metastasis is gastrectomy in combination with chemotherapy. Some patients cannot tolerate such treatment because of old age or comorbidities. In this study, we want to test the feasibility of Laparoscopic and Endoscopic Cooperative Surgery (LECS) as a less invasive treatment option. In LECS, the tumor margin is marked endoscopically, followed by surgical removal under endoscopic guidance. Currently, LECS is primarily used in Asian countries as a treatment for gastrointestinal stromal cell tumors. METHODS The study will be conducted as a prospective single-center, feasibility trial. The primary objective will be the safety of LECS, defined as Clavien-Dindo score ≥ III. The secondary objectives will be any complications, postoperative bleeding/perforation, operation time, radicality, mortality, hospital stay, and health-related quality of life. The inclusion criteria will be patients with gastric cancer cT2-T4aN0M0, Borrman type 1-2 < 5 cm, or type 3 < 2 cm that the tumor board assesses as not fit for gastrectomy. Exclusion criteria will be Borrman type 4 and lesions in the cardia. The patients will be followed up with an outpatient appointment 30 days after the procedure. DISCUSSION LECS is a promising treatment option for patients with gastric cancer who cannot tolerate gastrectomy. Compared to gastrectomy, LECS is a less invasive procedure with a documented low complication rate. No previous prospective studies have been conducted to evaluate LECS for advanced gastric cancer. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT06105515. Registered 23 October 2023. https://clinicaltrials.gov/study/NCT06105515?cond=Gastric%20Cancer&term=NCT06105515&aggFilters=status:not%20rec&rank=1.
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Affiliation(s)
- Henrik Maltzman
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Surgery and Oncology, Karolinska Institutet, Hälsovägen 13, 141 57, Huddinge, Stockholm, Sweden
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Masami Omae
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Surgery and Oncology, Karolinska Institutet, Hälsovägen 13, 141 57, Huddinge, Stockholm, Sweden
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Medicine, Department of Upper Gastrointestinal Diseases, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Fredrik Klevebro
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Surgery and Oncology, Karolinska Institutet, Hälsovägen 13, 141 57, Huddinge, Stockholm, Sweden
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Francisco Baldaque-Silva
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Surgery and Oncology, Karolinska Institutet, Hälsovägen 13, 141 57, Huddinge, Stockholm, Sweden
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Medicine, Department of Upper Gastrointestinal Diseases, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
- Gastroenterology Department, Advanced Endoscopy Center Carlos Moreira da Silva, Hospital Pedro Hispano, Senhora da Hora, Portugal
| | - Ioannis Rouvelas
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Surgery and Oncology, Karolinska Institutet, Hälsovägen 13, 141 57, Huddinge, Stockholm, Sweden.
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden.
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Ito S, Tamazaki R, Maeda S, Hosoda K. Laparoscopic and endoscopic co-operative surgery for a non-ampullary duodenal tumor after living-donor liver transplantation: a case report. J Surg Case Rep 2025; 2025:rjaf023. [PMID: 39845523 PMCID: PMC11752857 DOI: 10.1093/jscr/rjaf023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2024] [Accepted: 01/10/2025] [Indexed: 01/24/2025] Open
Abstract
Superficial duodenal epithelial tumors were previously considered rare. Laparoscopic and endoscopic cooperative surgery for duodenal tumors (D-LECS) has been developed to achieve successful endoscopic treatment. Patients who have undergone living-donor liver transplantation (LDLT) may have severe abdominal adhesions, and immunosuppressive agents (IAs) may affect the degree of postoperative abdominal adhesions and wound healing, but their effects remain unclear. Herein, we present the first case of D-LECS for duodenal adenoma after LDLT. A 66-year-old man underwent D-LECS for a non-ampullary duodenal high-grade adenoma after LDLT with an IA. The patient's condition was uneventful 36 months after the surgery. In gastrointestinal surgery, IAs may affect the resected duodenal repair process. For duodenal neoplasms in high-risk patients, D-LECS may be better than endoscopic submucosal dissection alone. D-LECS after LDLT is a feasible and less invasive procedure.
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Affiliation(s)
- Shunichi Ito
- Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, 8-1, Kawadacho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Rinka Tamazaki
- Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, 8-1, Kawadacho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Shinsuke Maeda
- Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, 8-1, Kawadacho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Kei Hosoda
- Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, 8-1, Kawadacho, Shinjuku-ku, Tokyo 162-8666, Japan
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Enomoto T, Mikami S, Otsubo T, Hiwatari M, Tsukamoto Y, Hisatsune Y, Shimada J, Matsushita T. Retrospective observational cohort study of laparoscopic surgical strategies for gastrointestinal stromal tumors. Updates Surg 2024; 76:2285-2292. [PMID: 38578408 PMCID: PMC11541388 DOI: 10.1007/s13304-024-01816-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 03/04/2024] [Indexed: 04/06/2024]
Abstract
Laparoscopic surgery has been used to treat gastric submucosal tumors (SMTs). Laparoscopic and endoscopic cooperative surgery (LECS) has been used when subtotal resection has been difficult, which enabled resection of these tumors. In this study, we reviewed the medical records of patients with gastric SMTs who underwent laparoscopic surgery in our hospital with the aim of reporting the surgical indications, procedures (especially for LECS), and outcomes of surgery. This study involved 55 patients who underwent laparoscopic surgery between April 2014 and March 2021. We classified the patients into two groups: laparoscopy-assisted surgery group (non-LECS group, n = 30) and LECS group (n = 25). LECS was performed in the upper stomach, in the greater curvature of the lower stomach, and in both intraluminal and intramural locations in the middle stomach. Non-LECS was selected for extraluminal and intramural tumors in the greater curvature of the upper stomach. There were no severe complications associated with the operation. There was one postoperative complication in the LECS group. The length of postoperative hospital stay did not significantly differ between the LECS and non-LECS groups. We reported the surgical procedures for gastric SMTs in our hospital. It is essential to make full use of the multiple techniques reported in this article and examine the location of the tumor to avoid excess or insufficient resection. Our review of the present case series allowed us to select the appropriate surgical approach for gastric SMTs based on the lesion location and type of development.
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Affiliation(s)
- Takeharu Enomoto
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan.
| | - Shinya Mikami
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Takehito Otsubo
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Masaki Hiwatari
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Yoshitsugu Tsukamoto
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Yasuhito Hisatsune
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Jin Shimada
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Tsunehisa Matsushita
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
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Miwa T, Ishibashi Y, Hatao F, Shimoji K, Imamura K, Morita Y. Laparoscopic endoscopic cooperative surgery for gastric subepithelial lesion during laparoscopic sleeve gastrectomy for severe obesity. Surg Case Rep 2024; 10:223. [PMID: 39325225 PMCID: PMC11427647 DOI: 10.1186/s40792-024-02027-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Accepted: 09/16/2024] [Indexed: 09/27/2024] Open
Abstract
BACKGROUND The frequency of pathologies detected incidentally before, during, and after a bariatric surgery, such as subepithelial lesion (SEL) of the stomach, is likely to rise as bariatric surgery becomes more common. CASE PRESENTATION A 49-year-old female patient presented with severe obesity, for which laparoscopic sleeve gastrectomy (LSG) was planned. During a preoperative examination, endoscopy revealed a 10 mm SEL in the posterior wall of the upper body of the stomach. Excision of the SEL was performed simultaneously with the LSG. Endoscopy demonstrated that the SEL was situated on the remnant side of the stomach. Endoscopic resection using laparoscopic endoscopic cooperative surgery was performed for the SEL, and the thinned gastric wall was closed by hand-sewing. Thereafter, LSG was performed. Pathological analysis of the SEL led to a diagnosis of leiomyoma. The patient was discharged on postoperative day 6. CONCLUSION Surgeons should be prepared to manage incidentally detected pathologies before, during, and after bariatric surgery and to choose the surgical method most suitable to the individual patient.
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Affiliation(s)
- Takumi Miwa
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, 183-8524, Japan
| | - Yuji Ishibashi
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, 183-8524, Japan.
| | - Fumihiko Hatao
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, 183-8524, Japan
| | - Kohei Shimoji
- Department of Gastroenterology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Kazuhiro Imamura
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, 183-8524, Japan
| | - Yasuhiro Morita
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, 183-8524, Japan
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12
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Hara H, Shimizu S, Muto Y, Kido T, Miyata R, Tokuda M, Takahashi K, Maesono T, Ajihara T, Yagi A, Naritomi T, Itabashi M. Successful modified CLEAN-NET with semicircular seromuscular layer incision for a gastric GIST near the cardia: a case report and video demonstration. World J Surg Oncol 2024; 22:239. [PMID: 39243070 PMCID: PMC11380435 DOI: 10.1186/s12957-024-03528-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 09/01/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND The combination of laparoscopic and endoscopic approaches to neoplasia with a non-exposure technique (CLEAN-NET) is a laparoscopic and endoscopic cooperative surgery (LECS). It combines laparoscopic gastric resection and endoscopic techniques for local resection of gastric tumors, such as gastrointestinal stromal tumors (GIST), with minimal surgical margins. A conventional CLEAN-NET surgical procedure is complex, requiring careful techniques to preserve the cardia, particularly in case of nearby lesions. We describe the case of a patient who underwent a modified CLEAN-NET approach with a semi-circular seromuscular layer incision surrounding the base of the tumor, different from a circular shape seromuscular layer in the conventional CLEAN-NET: around the tumor to preserve mucosal continuity, which acts as a barrier to avoid intraoperative tumor dissemination. CASE PRESENTATION A 43-year-old woman was referred to our hospital because of a gastric submucosal tumor near the cardia, detected on medical examination. The patient was diagnosed with gastric GIST based on the results of endoscopic ultrasound-guided fine-needle aspiration. Modified CLEAN-NET was performed with a semicircular incision of the seromuscular layer on the opposite side of the cardia, making the surgical procedure simple and minimizing partial resection of the gastric wall, including the tumor, while preserving the cardia. The operative time was 147 min, preoperative blood loss volume was 3 mL, and postoperative hospital stay was 9 days. The resected specimen revealed a minimal resection of the gastric wall, including the tumor. The cardia and gastric nerves were preserved, and the postoperative food intake was good. CONCLUSIONS The modified CLEAN-NET with semicircular seromuscular layer dissection is a simple and reliable surgical procedure for GIST near the cardia.
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Affiliation(s)
- Hitoshi Hara
- Department of Surgery, Social Welfare Organization Saiseikai Imperial Gift Foundation, Inc., Saiseikai Kazo Hospital, 1680 Kamitakayanagi, Kazo-city, Saitama, 347-0101, Japan.
| | - Seito Shimizu
- Department of Surgery, Social Welfare Organization Saiseikai Imperial Gift Foundation, Inc., Saiseikai Kazo Hospital, 1680 Kamitakayanagi, Kazo-city, Saitama, 347-0101, Japan
| | - Yasuhide Muto
- Department of Surgery, Social Welfare Organization Saiseikai Imperial Gift Foundation, Inc., Saiseikai Kazo Hospital, 1680 Kamitakayanagi, Kazo-city, Saitama, 347-0101, Japan
| | - Tomoki Kido
- Department of Surgery, Social Welfare Organization Saiseikai Imperial Gift Foundation, Inc., Saiseikai Kazo Hospital, 1680 Kamitakayanagi, Kazo-city, Saitama, 347-0101, Japan
| | - Ryohei Miyata
- Department of Surgery, Social Welfare Organization Saiseikai Imperial Gift Foundation, Inc., Saiseikai Kazo Hospital, 1680 Kamitakayanagi, Kazo-city, Saitama, 347-0101, Japan
| | - Moe Tokuda
- Department of Gastroenterology, Social Welfare Organization Saiseikai Imperial Gift Foundation, Inc., Saiseikai Kazo Hospital, Kazo, Saitama, Japan
| | - Kyuichiro Takahashi
- Department of Gastroenterology, Social Welfare Organization Saiseikai Imperial Gift Foundation, Inc., Saiseikai Kazo Hospital, Kazo, Saitama, Japan
| | - Tomohiro Maesono
- Department of Gastroenterology, Social Welfare Organization Saiseikai Imperial Gift Foundation, Inc., Saiseikai Kazo Hospital, Kazo, Saitama, Japan
| | - Takahiro Ajihara
- Department of Gastroenterology, Social Welfare Organization Saiseikai Imperial Gift Foundation, Inc., Saiseikai Kazo Hospital, Kazo, Saitama, Japan
| | - Aki Yagi
- Department of Gastroenterology, Social Welfare Organization Saiseikai Imperial Gift Foundation, Inc., Saiseikai Kazo Hospital, Kazo, Saitama, Japan
| | - Takuma Naritomi
- Department of Gastroenterology, Social Welfare Organization Saiseikai Imperial Gift Foundation, Inc., Saiseikai Kazo Hospital, Kazo, Saitama, Japan
| | - Michio Itabashi
- Department of Surgery, Social Welfare Organization Saiseikai Imperial Gift Foundation, Inc., Saiseikai Kazo Hospital, 1680 Kamitakayanagi, Kazo-city, Saitama, 347-0101, Japan
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13
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Hashimoto Y, Abe N, Nunobe S, Kawakubo H, Sumiyoshi T, Yoshida N, Morita Y, Terashima M, Saze Z, Onimaru M, Otsuji E, Hoteya S, Yamashita H, Fujimura T, Oyama T, Ohata K, Shichijo S, Tanabe K, Shuto K, Ikeya T, Shinohara H, Tanabe S, Hiki N. Outcomes of laparoscopic and endoscopic cooperative surgery for gastric submucosal tumors: A retrospective multicenter study at 21 Japanese institutions. Ann Gastroenterol Surg 2024; 8:778-786. [PMID: 39229548 PMCID: PMC11368495 DOI: 10.1002/ags3.12787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/05/2024] [Accepted: 02/23/2024] [Indexed: 09/05/2024] Open
Abstract
AIM We conducted a multicenter study on classical laparoscopic and endoscopic cooperative surgery (LECS) and LECS-related procedures to retrospectively clarify the safety, problems, and mid-term outcomes of these methods after their coverage by the national health insurance. METHODS A total of 201 patients who underwent classical LECS/LECS-related procedures for gastric submucosal tumors (G-SMTs) in 21 institutions affiliated with the Laparoscopy Endoscopy Cooperative Surgery Study Group from April 2014 to March 2016 were included. Data was retrospectively obtained from the patients' charts. RESULTS The most common surgical procedure was classical LECS (155 patients, 77.1%), non-exposed endoscopic wall inversion surgery (22 patients, 11.4%), a combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique (16 patients, 8%), and closed LECS (two patients, 1%). Only six (3%) patients underwent LECS with gastrostomy. The mean operative time and blood loss were 188.4 (70-462) minutes and 23.3 (0-793) g, respectively. Ten (5%) patients developed postoperative complications (Clavien-Dindo classification grade II or higher). Two patients needed reoperation due to postoperative bleeding or anastomotic leakage. All tumors were resected with negative margins. A total of 127 (63.2%) patients underwent follow-up observations for over 36 months, one of whom had a recurrence of peritoneal dissemination and one had poor oral intake. CONCLUSION Classical LECS and LECS-related procedures for G-SMTs have favorable short/mid-term outcomes.
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Affiliation(s)
- Yoshikazu Hashimoto
- Department of Gastroenterological and General SurgeryKyorin University Faculty of MedicineTokyoJapan
| | - Nobutsugu Abe
- Department of Gastroenterological and General SurgeryKyorin University Faculty of MedicineTokyoJapan
| | - Souya Nunobe
- Department of Gastroenterological SurgeryCancer Institute Ariake HospitalTokyoJapan
| | | | | | - Naohiro Yoshida
- Department of GastroenterologyIshikawa Prefectural Central HospitalKanazawaJapan
| | - Yoshinori Morita
- Department of GastroenterologyKobe University International Clinical Cancer Research CenterHyogoJapan
| | | | - Zenichiro Saze
- Department of Gastrointestinal Tract SurgeryFukushima Medical UniversityFukushimaJapan
| | - Manabu Onimaru
- Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
| | - Eigo Otsuji
- Division of Digestive Surgery, Department of SurgeryKyoto Prefectural University of MedicineKyotoJapan
| | - Shu Hoteya
- Department of GastroenterologyToranomon HospitalTokyoJapan
| | - Haruhiro Yamashita
- Department of Gastrointestinal OncologyNational Hospital Organization Okayama Medical CenterOkayamaJapan
| | | | - Tsuneo Oyama
- Department of EndoscopySaku Central Hospital Advanced Care CenterNaganoJapan
| | - Ken Ohata
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Satoki Shichijo
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Kazuaki Tanabe
- Department of Perioperative and Critical Care Management, Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Kiyohiko Shuto
- Department of SurgeryTeikyo University Chiba Medical CenterChibaJapan
| | - Takashi Ikeya
- Department of GastroenterologySt. Luke's International HospitalTokyoJapan
| | - Hisashi Shinohara
- Department of Gastroenterological SurgeryHyogo Medical UniversityHyogoJapan
| | - Satoshi Tanabe
- Department of Advanced Medicine Research and Development Center for New Medical FrontiersKitasato University School of MedicineKanagawaJapan
| | - Naoki Hiki
- Department of Upper Gastrointestinal SurgeryKitasato University School of MedicineKanagawaJapan
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14
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Zhou J, Li R, Zhao S, Sun L, Wang J, Fu Y, Wang D. Sentinel Node Navigation Surgery for Early Gastric Cancer: A Narrative Review. Am J Clin Oncol 2024; 47:439-444. [PMID: 38587337 DOI: 10.1097/coc.0000000000001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Early gastric cancer (EGC) refers to malignant tumor lesions that are limited to the mucosa and submucosa layers, regardless of the presence of lymph node metastasis. Typically, EGC has a low rate of perigastric lymph node metastasis, and long-term survival outcomes are good after radical surgical treatment. The primary objective of surgical treatment for EGC is to achieve functional preservation while ensuring a radical cure. Sentinel node navigation surgery (SNNS) is a surgical technique used in the treatment of EGC. This approach achieves functional preservation by limiting lymph node dissection and performing restrictive gastrectomy guided by intraoperative negative sentinel node (SN) biopsy. Despite the apparent improvement in the detection rate of SN with the emergence of various tracing dyes and laparoscopic fluorescence systems, the oncological safety of SNNS remains a controversial research topic. SNNS, as a true form of stomach preservation surgery that enhances the quality of life, has become a topic of interest in the EGC field. In recent years, scholars from Japan and South Korea have conducted extensive research on the feasibility and safety of SNNS in the treatment of EGC. This article aims to provide reference choices for surgeons treating EGC by reviewing relevant research on SNNS for EGC in recent years.
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Affiliation(s)
- Jiajie Zhou
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
| | - Ruiqi Li
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
| | - Shuai Zhao
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
| | - Longhe Sun
- Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Jie Wang
- Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Yayan Fu
- Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Daorong Wang
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
- Northern Jiangsu People's Hospital, Yangzhou, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Disease, Yangzhou, China
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15
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Popoiu TA, Pîrvu CA, Popoiu CM, Iacob ER, Talpai T, Voinea A, Albu RS, Tãban S, Bãlãnoiu LM, Pantea S. Gastrointestinal Stromal Tumors (GISTs) in Pediatric Patients: A Case Report and Literature Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:1040. [PMID: 39334573 PMCID: PMC11429550 DOI: 10.3390/children11091040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 08/18/2024] [Accepted: 08/23/2024] [Indexed: 09/30/2024]
Abstract
Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms that primarily affect adults, with pediatric cases constituting only 0.5-2.7% of the total. Pediatric GISTs present unique clinical, genetic, and pathological features that distinguish them from adult cases. This literature review aims to elucidate these differences, emphasizing diagnostic and therapeutic challenges. We discuss the resistance of pediatric GISTs to conventional chemotherapy and highlight the importance of surgical intervention, especially in emergency situations involving intra-abdominal bleeding. The review also explores the molecular characteristics of pediatric GISTs, including rare mutations such as quadruple-negative wild-type GIST with an FGF3 gene gain mutation. To illustrate these points, we conclude with a case from our clinic involving a 15-year-old female with multiple CD117-positive gastric GISTs and a quadruple-negative wild-type genetic profile who required urgent surgical intervention following a failed tumor embolization. This case underscores the critical need for early diagnosis and individualized therapeutic strategies combining oncologic and surgical care to improve outcomes in pediatric GIST patients.
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Affiliation(s)
- Tudor-Alexandru Popoiu
- Department of General Surgery, "Victor Babeş" University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department III of Functional Sciences, Discipline of Medical Informatics and Biostatistics, "Victor Babeş" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Cãtãlin-Alexandru Pîrvu
- Department of General Surgery, "Victor Babeş" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Cãlin-Marius Popoiu
- Department of Pediatric Surgery, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Emil Radu Iacob
- Department of Pediatric Surgery, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Tamas Talpai
- Department of General Surgery, "Victor Babeş" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Amalia Voinea
- Department of General Surgery, "Victor Babeş" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Rãzvan-Sorin Albu
- Department of General Surgery, "Victor Babeş" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Sorina Tãban
- Department of Pathology, "Victor Babeş" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Larisa-Mihaela Bãlãnoiu
- Department of General Surgery, "Victor Babeş" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Stelian Pantea
- Department of General Surgery, "Victor Babeş" University of Medicine and Pharmacy, 300041 Timisoara, Romania
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16
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Yasuda A, Kimura Y, Kato H, Nakanishi T, Koda M, Hiraki Y, Hagi T, Shiraishi O, Shinkai M, Imano M, Yasuda T. Surgical tips and tricks for laparoscopic intragastric surgery for submucosal tumors relative to the esophagogastric junction. Updates Surg 2024; 76:1389-1396. [PMID: 38216795 DOI: 10.1007/s13304-023-01740-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 12/19/2023] [Indexed: 01/14/2024]
Abstract
Recent reports have described the practicality of laparoscopic intragastric surgery (l-IGS) as an alternative for resecting submucosal tumors (SMTs) near the esophagogastric junction (EGJ), where excision using an exogastric approach would be difficult. However, even using IGS to perform a full-thickness resection of SMTs that are in or extremely close to the EGJ is very difficult to do safely and avoid disrupting or causing stenosis of the EGJ, without advanced experience. This study retrospectively examined the usefulness of l-IGS for gastric SMTs located in or extremely close to the EGJ. Fourteen patients with gastric SMTs < 2 cm of the EGJ and underwent l-IGS were eligible for this study. We examined the tumor location, operative time, intraoperative hemorrhage, degree of deformation, gastroesophageal reflux disease, perioperative complications, and recurrence. Furthermore, we compared patients with tumors in the EGJ with those with tumors near the EGJ and patients in whom three-port l-IGS was performed with those who underwent single-incision laparoscopic surgery. The average tumor size, operative time, intraoperative hemorrhage, and postoperative hospitalization of the 14 patients were 30.9 ± 21.3 mm, 125.2 ± 31.1 min, 30.7 ± 103.3 mL, and 9.2 ± 3.1 d, respectively. No differences in these parameters according to the type of l-IGS or tumor location were observed. All patients underwent l-IGS without complications and were free from EGJ deformation or esophagitis. We believe that l-IGS is useful for gastric SMTs located < 2 cm of the EGJ as it can be safely performed for difficult tumor locations and does not cause deformation of the EGJ.
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Affiliation(s)
- Atsushi Yasuda
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
| | - Yutaka Kimura
- Department of Surgery, Kindai Nara Hospital, 1248-1 Otoda-Tyo, Ikoma, Nara, 650-0293, Japan
| | - Hiroaki Kato
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Tomoya Nakanishi
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Masashi Koda
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Yoko Hiraki
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Takaomi Hagi
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Osamu Shiraishi
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Masayuki Shinkai
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Motohiro Imano
- Cancer Center, Kindai University Hospital, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Takushi Yasuda
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
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17
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Goto O, Iwakiri K. Excision and closure: Challenge to surgery by endoscopists. Dig Endosc 2024; 36:822-824. [PMID: 38380544 DOI: 10.1111/den.14766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/21/2024] [Indexed: 02/22/2024]
Affiliation(s)
- Osamu Goto
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
- Endoscopy Center, Nippon Medical School Hospital, Tokyo, Japan
| | - Katsuhiko Iwakiri
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
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18
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Kobayashi R, Hirasawa K, Ozeki Y, Sawada A, Nishio M, Sato C, Miwa H, Kaneko T, Sugimori K, Maeda S. Clinical course of small gastric subepithelial lesion less than 20 mm diagnosed by endoscopic ultrasound-guided fine-needle aspiration. J Gastroenterol Hepatol 2024; 39:1285-1290. [PMID: 38450593 DOI: 10.1111/jgh.16534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 01/26/2024] [Accepted: 02/20/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND AND AIM Gastrointestinal stromal tumors (GISTs) are treated as malignant gastric subepithelial lesions (SELs), and resection is recommended. However, small gastric SELs < 20 mm with no malignant features are monitored without histopathological examination, and the frequency of malignancy is unknown. This study aimed to clarify the clinicopathological findings and clinical course of gastric SELs < 20 mm measured by endoscopic ultrasound (EUS). METHODS This retrospective cohort study included consecutive patients with small gastric SELs < 20 mm diagnosed using EUS at a tertiary referral center between 2009 and 2021. The clinical course after diagnosis using EUS-guided fine-needle aspiration (EUS-FNA) was reviewed. RESULTS Among 333 patients with small gastric SELs, 104 patients with 105 lesions underwent EUS-FNA. The pathological diagnosis was confirmed in 87 patients. GISTs were the most common pathology (47%). Among the 87 patients, 43 underwent therapeutic interventions, including tumor resection and chemotherapy. In groups of tumor resection, the pathological tumor size on the resected specimen was significantly larger than the size measured by EUS (19.5 mm vs 15.0 mm, P < 0.001), and 37% of resected SELs were 20 mm or over. No recurrence was observed after tumor resection during a mean follow-up period of 40 months. CONCLUSIONS Approximately 40% of small gastric SELs were malignant tumors, such as GIST, with most of them requiring treatment. Additionally, considering that the EUS measurement is 5 mm smaller than the pathological tumor diameter, further examinations, such as systematic EUS-FNA, may be required for SEL, including those smaller than 20 mm.
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Affiliation(s)
- Ryosuke Kobayashi
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Kingo Hirasawa
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Yuichiro Ozeki
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Atsushi Sawada
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Masafumi Nishio
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Chiko Sato
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Haruo Miwa
- Department of Gastroenterology, Yokohama City University Medical Center, Yokohama, Japan
| | - Takashi Kaneko
- Department of Gastroenterology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazuya Sugimori
- Department of Gastroenterology, Yokohama City University Medical Center, Yokohama, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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19
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Shichijo S, Uedo N, Sawada A, Hirasawa K, Takeuchi H, Abe N, Miyaoka M, Yao K, Dobashi A, Sumiyama K, Ishida T, Morita Y, Ono H. Endoscopic full-thickness resection for gastric submucosal tumors: Japanese multicenter prospective study. Dig Endosc 2024; 36:811-821. [PMID: 37914400 DOI: 10.1111/den.14717] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/30/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVES Early gastric cancer endoscopic resection (ER) is prominent in Japan. However, evidence regarding ER of gastric submucosal tumors (SMT) is limited. This prospective multicenter phase II study investigated the efficacy and safety of endoscopic full-thickness resection (EFTR) for gastric SMT. METHODS Endoscopic full-thickness resection indication for gastric SMT was 11-30 mm, histologically proven or clinically suspicious (irregular margin, increasing size, or internal heterogeneity) gastrointestinal stromal tumors (GIST), with no ulceration and intraluminal growth type. The primary end-point was the complete ER (ER0) rate, with a sample size of 42. RESULTS We enrolled 46 patients with 46 lesions between September 2020 and May 2023 at seven Japanese institutions. The mean ± SD (range) endoscopic tumor size was 18.8 ± 4.5 (11-28) mm. The tumor resection and defect closure times were 54 ± 26 (22-125) min and 33 ± 28 (12-186) min, respectively. A 100% ER0 was achieved in all 46 patients. The EFTR procedure was accomplished in all patients without surgical intervention. One patient had delayed perforation and was managed endoscopically. GIST accounted for 76% (n = 35) of the cases. R0, R1, and RX rates were 33 (77%), 3 (6.5%), and 7 (15%), respectively. CONCLUSION Endoscopic full-thickness resection for gastric SMT of 11-30 mm is efficacious. It warrants further validation in a large-scale cohort study to determine the long-term outcome of this treatment for patients with gastric GIST.
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Affiliation(s)
- Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Atsushi Sawada
- Endoscopy Division, Yokohama City University Medical Center, Kanagawa, Japan
| | - Kingo Hirasawa
- Endoscopy Division, Yokohama City University Medical Center, Kanagawa, Japan
| | - Hirohisa Takeuchi
- Department of Gastroenterological and General Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Nobutsugu Abe
- Department of Gastroenterological and General Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Masaki Miyaoka
- Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Kenshi Yao
- Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Akira Dobashi
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazuki Sumiyama
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Tsukasa Ishida
- Department of Gastroenterology, Akashi Medical Center, Hyogo, Japan
| | - Yoshinori Morita
- Department of Gastroenterology, Kobe University International Clinical Cancer Research Center, Kobe, Japan
| | - Hiroyuki Ono
- Endoscopy Division, Shizuoka Cancer Center, Shizuoka, Japan
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20
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Chai Y, Lin B, Zhong J, Wu X, Lin X, Ge X, Jiang J, Liang Z, Liu S, Gu C. Long-term outcomes of endoscopic therapy versus surgical resection for 2-5 cm gastric gastrointestinal stromal tumors: A population-based comparative study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108262. [PMID: 38531231 DOI: 10.1016/j.ejso.2024.108262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/02/2024] [Accepted: 03/08/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Endoscopic therapy (ET) of gastrointestinal stromal tumors (GIST) has become a viable treatment. We intended to compare long-term outcomes of ET versus surgical resection for 2-5 cm GIST using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS A multicenter retrospective study was conducted to compare the long-term outcomes of patients treated with ET and surgical resection for GIST. The multivariate Cox proportional hazards models were used to identify predictors for patients survival. To balance the clinicopathologic characteristics, a 1:1 propensity score matching (PSM) was utilized. RESULTS A total of 749 patients with 2-5 cm GIST were enrolled, of whom 113 accepted ET and 636 underwent surgical resection. Before PSM, there was no significant difference in long-term outcomes between ET and surgical resection (5-year overall survival (OS): 93.5% vs. 91.6%, P=0.374; 5-year cancer-specific survival (CSS): 99.1% vs. 96.5%, P=0.546; 10-year OS: 71.1% vs. 78.2%, P=0.374; 10-year CSS: 93.6% vs. 92.7%, P=0.546). After adjusting for the relevant variables using the multivariable Cox proportional hazards models, we observed that the ET and surgical resection groups were similar in OS (HR 0.726, 95%CI 0.457-1.153, P=0.175) and CSS (HR 1.286, 95%CI 0.474-3.488, P=0.621). After PSM, the long-term OS and CSS of patients with 2-5 cm GIST after ET and surgical resection were comparable. CONCLUSIONS We found that the long-term survival of patients with 2-5 cm gastric GIST after ET and surgical resection were comparable. Further high-quality studies are needed to confirm the role of ET in 2-5 cm GIST.
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Affiliation(s)
- Yixia Chai
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Bitao Lin
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jun Zhong
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Xiaosheng Wu
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Xin Lin
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Xiaoyue Ge
- Department of General Practice, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jiayi Jiang
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Zhenye Liang
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-Sen University · Zhao Qing Hospital, Zhaoqing 526000, China.
| | - Side Liu
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Chuncai Gu
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
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21
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Li CY, Wang YF, Luo LK, Yang XJ. Present situation of minimally invasive surgical treatment for early gastric cancer. World J Gastrointest Oncol 2024; 16:1154-1165. [PMID: 38660633 PMCID: PMC11037069 DOI: 10.4251/wjgo.v16.i4.1154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/05/2023] [Accepted: 02/02/2024] [Indexed: 04/10/2024] Open
Abstract
Minimally invasive surgery is a kind of surgical operation, which is performed by using professional surgical instruments and equipment to inactivate, resect, repair or reconstruct the pathological changes, deformities and wounds in human body through micro-trauma or micro-approach, in order to achieve the goal of treatment, its surgical effect is equivalent to the traditional open surgery, while avoiding the morbidity of conventional surgical wounds. In addition, it also has the advantages of less trauma, less blood loss during operation, less psychological burden and quick recovery on patients, and these minimally invasive techniques provide unique value for the examination and treatment of gastric cancer patients. Surgical minimally invasive surgical techniques have developed rapidly and offer numerous options for the treatment of early gastric cancer (EGC): endoscopic mucosal resection (EMR), underwater EMR (UEMR), endoscopic submucosal dissection (ESD), endoscopic full-thickness resection (EFTR), endoscopic submucosal excavation (ESE), submucosal tunnel endoscopic resection), laparoscopic and endoscopic cooperative surgery (LECS); Among them, EMR, EFTR and LECS technologies have a wide range of applications and different modifications have been derived from their respective surgical operations, such as band-assisted EMR (BA-EMR), conventional EMR (CEMR), over-the-scope clip-assisted EFTR, no-touch EFTR, the inverted LECS, closed LECS, and so on. These new and improved minimally invasive surgeries are more precise, specific and effective in treating different types of EGC.
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Affiliation(s)
- Chun-Yan Li
- The First Clinical Medical School, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Yi-Feng Wang
- The First Clinical Medicine College, Gansu University of Chinese Medicine, Lanzhou 730000, Gansu Province, China
| | - Li-Kang Luo
- The First Clinical Medicine College, Gansu University of Chinese Medicine, Lanzhou 730000, Gansu Province, China
| | - Xiao-Jun Yang
- The First Clinical Medical School, Lanzhou University, Lanzhou 730000, Gansu Province, China
- General Surgery Clinical Centre, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
- The Second Department of General Surgery, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
- Lanzhou University People's Clinical Hospital, Lanzhou 730000, Gansu Province, China
- Gansu Research Center of Prevention and Control Project for Digestive Oncology, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
- Gansu Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
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22
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Khaled I, Hafez Mousa A, Yasir Nukaly H, Mohammed Zubair MT, Alsharif MH, Abujamai JZ, Ahmed RA, Alklani T, Ennab F. Hybrid surgical approach excision of gastrointestinal stromal tumor (GIST): A case report of GIST at an unusual location and review of the literature. Clin Case Rep 2024; 12:e8778. [PMID: 38659501 PMCID: PMC11039485 DOI: 10.1002/ccr3.8778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 02/02/2024] [Accepted: 03/27/2024] [Indexed: 04/26/2024] Open
Abstract
Gastrointestinal stromal tumors are the most common malignant subepithelial lesions involving the gastrointestinal tract. Surgical techniques have been the mainstay of treatment, however, in recent times hybrid surgeries are being introduced yielding better clinical outcomes.
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Affiliation(s)
- Islam Khaled
- Department of SurgerySaudi German HospitalsJeddahSaudi Arabia
- Department of Surgery, Faculty of MedicineSuez Canal University HospitalsIsmailiaEgypt
| | - Ahmed Hafez Mousa
- Department of SurgerySaudi German HospitalsJeddahSaudi Arabia
- College of Medicine and SurgeryBatterjee Medical CollegeJeddahSaudi Arabia
| | | | | | | | | | - Ruqayyah Ali Ahmed
- College of Medicine and SurgeryBatterjee Medical CollegeJeddahSaudi Arabia
| | | | - Farah Ennab
- College of MedicineMohammed Bin Rashid University of Medicine and Health SciencesDubaiUnited Arab Emirates
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23
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Fujishiro M. Advanced Diagnostic and Therapeutic Endoscopy for Early Gastric Cancer. Cancers (Basel) 2024; 16:1039. [PMID: 38473395 DOI: 10.3390/cancers16051039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/01/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
Endoscopy is mandatory to detect early gastric cancer (EGC). When considering the cost-effectiveness of the endoscopic screening of EGC, risk stratification by combining serum pepsinogen values and anti-H. pylori IgG antibody values is very promising. After the detection of suspicious lesions of EGC, a detailed observation using magnifying endoscopy with band-limited light is necessary, which reveals an irregular microsurface and/or an irregular microvascular pattern with demarcation lines in the case of cancerous lesions. Endocytoscopy enables us to make an in vivo histological diagnosis. In terms of the indications for endoscopic resection, the likelihood of lymph node metastasis and technical difficulties in en bloc resection is considered, and they are divided into absolute, expanded, and relative indications. Endoscopic mucosal resection and endoscopic submucosal dissection are the main treatment modalities nowadays. After endoscopic resection, curability is evaluated histologically as endoscopic curability (eCura) A, B, and C (C-1 and C-2). Recent evidence suggests that the outcomes of endoscopic resection for many EGCs are comparable to those of gastrectomy and that endoscopic resection is the gold standard for node-negative early gastric cancers. Personalized medicine is also being developed to overcome the unmet needs in treatments of EGC, for example the further expansion of indications and newer resection techniques, such as full-thickness resection.
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Affiliation(s)
- Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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24
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Tsuji T, Okamoto K, Saito H, Shimada M, Moriyama H, Kinoshita J, Takatori H, Inaki N. Thoracoscopic endoscopic cooperative surgery for gastric tube cancer after esophagectomy: a case report. J Surg Case Rep 2024; 2024:rjae034. [PMID: 38322358 PMCID: PMC10838677 DOI: 10.1093/jscr/rjae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/14/2024] [Indexed: 02/08/2024] Open
Abstract
The incidence of gastric tube cancer (GTC) is increasing due to the improved prognosis of patients after esophagectomy for esophageal cancer. Total resection of the gastric tube is expected to be curative for patients with GTC. However, several studies have reported that this procedure is associated with high mortality and morbidity rates. We here present a case of GTC without lymph node metastasis in a patient who underwent partial resection of a gastric tube via thoracoscopic-endoscopic cooperative surgery. No postoperative complications or recurrence was observed. This procedure is a favorable and minimally invasive procedure for GTC without lymph node metastasis.
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Affiliation(s)
- Toshikatsu Tsuji
- Department of Gastrointestinal Surgery/Breast Surgery, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641, Japan
| | - Koichi Okamoto
- Department of Gastrointestinal Surgery/Breast Surgery, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641, Japan
- Department of General and Digestive Surgery, Kanazawa Medical University Hospital, 1-1 Digaku, Uchinadamachi, Ishikawa, Kahoku, Ishikawa 920-0293, Japan
| | - Hiroto Saito
- Department of Gastrointestinal Surgery/Breast Surgery, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641, Japan
| | - Mari Shimada
- Department of Gastrointestinal Surgery/Breast Surgery, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641, Japan
| | - Hideki Moriyama
- Department of Gastrointestinal Surgery/Breast Surgery, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641, Japan
| | - Jun Kinoshita
- Department of Gastrointestinal Surgery/Breast Surgery, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641, Japan
| | - Hajime Takatori
- Department of Gastroenterology, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641, Japan
| | - Noriyuki Inaki
- Department of Gastrointestinal Surgery/Breast Surgery, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641, Japan
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25
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Kim CG. Endoscopic Treatment for Gastric Subepithelial Tumor. J Gastric Cancer 2024; 24:122-134. [PMID: 38225771 PMCID: PMC10774759 DOI: 10.5230/jgc.2024.24.e11] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/21/2023] [Accepted: 12/21/2023] [Indexed: 01/17/2024] Open
Abstract
Most gastric subepithelial tumors (SETs) are asymptomatic and are often incidentally discovered during endoscopic procedures conducted for unrelated reasons. Although surveillance is sufficient for the majority of gastric SETs, certain cases necessitate proactive management. Laparoscopic wedge resection, although a viable treatment option, has its limitations, particularly in cases where SETs (especially those with intraluminal growth) are not visualized on the peritoneal side. Recent advances in endoscopic instruments and technology have paved the way for the feasibility of endoscopic resection of SETs. Several promising endoscopic techniques have emerged for gastric SET resection, including submucosal tunneling endoscopic resection, endoscopic full-thickness resection (EFTR), laparoscopic and endoscopic cooperative surgery (LECS), and non-exposure EFTR (non-exposed endoscopic wall-inversion surgery and non-exposure simple suturing EFTR). This study aimed to discuss the indications, methods, and outcomes of endoscopic therapy for gastric SETs. In addition, a simplified diagram of the category of SETs according to the therapeutic indications and an algorithm for the endoscopic management of SET is suggested.
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Affiliation(s)
- Chan Gyoo Kim
- National Cancer Center, Center for Gastric Cancer, Goyang, Korea.
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26
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Muranaka F, Kitazawa M, Iwaya Y, Tokumaru S, Nakamura S, Koyama M, Yamamoto Y, Hondo N, Soejima Y. Transmesenteric approach for laparoscopic endoscopic cooperative surgery for a duodenal adenoma located in the third portion of the duodenum. Asian J Endosc Surg 2023; 16:822-826. [PMID: 37448191 DOI: 10.1111/ases.13228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023]
Abstract
We report our experience in a patient with adenoma located in the horizontal part of the duodenum, which was effectively treated with the transmesenteric laparoscopic endoscopic cooperative surgery (LECS) approach. This approach, which entails incising the mesentery of the colon, simplified laparoscopic access to the horizontal part of the duodenum, which was minimally mobilized. Thus, the bulb and descending part of the duodenum were fixed to the retroperitoneum, facilitating stable handling of the endoscope and enabled safe and effective excision of an adenoma located in the horizontal part of the duodenum. This approach enabled safe and effective excision of an adenoma located in the horizontal part of the duodenum. The advantages of this method include a secure field of view, lower probability of damage to large vessels, and minimizing the defect to the intestine caused by the incision.
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Affiliation(s)
- Futoshi Muranaka
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masato Kitazawa
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yugo Iwaya
- Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shigeo Tokumaru
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Satoshi Nakamura
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Makoto Koyama
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuta Yamamoto
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Nao Hondo
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuji Soejima
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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27
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Zhao Z, Jiao Y, Yang S, Zhou A, Zhao G, Guo S, Li P, Zhang S. Endoscopic diagnosis and treatment of superficial non-ampullary duodenal epithelial tumors: A review. J Transl Int Med 2023; 11:206-215. [PMID: 37662895 PMCID: PMC10474890 DOI: 10.2478/jtim-2023-0102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
The surface of the small bowel mucosa is covered more than any other section of the digestive canal; however, the overall prevalence of small bowel tumors of the whole gastrointestinal tract is evidently low. Owing to the improvement in endoscopic techniques, the prevalence of small bowel tumors has increased across multiple countries, which is mainly due to an increase in duodenal tumors. Superficial non-ampullary duodenal epithelial tumors (SNADETs) are defined as tumors originating from the non-ampullary region in the duodenum that share similarities and discrepancies with their gastric and colorectal counterparts in the pathogenesis and clinicopathologic characteristics. To date, white light endoscopy (WLE) remains the cornerstone of endoscopic diagnosis for SNADETs. Besides, narrow-band imaging (NBI) techniques and magnifying endoscopy (ME) have been widely used in the clinic and endorsed by multiple guidelines and consensuses for SNADETs' evaluation. Confocal laser endomicroscopy (CLE), endocytoscopy (ECS), and artificial intelligence (AI) are also up-and-coming methods, showing an exceptional value in the diagnosis of SNADETs. Similar to the endoscopic treatment for colorectal polyps, the choices for SNADETs mainly include cold snare polypectomy (CSP), endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and laparoscopic endoscopic cooperative surgery (LECS). However, owing to the narrow lumen, rich vascularity, weak muscle layer, abundant Brunner's gland, and the hardship of endoscope control, the duodenum ranks as one of the most dangerous operating areas in the digestive tract. Therefore, endoscopists must anticipate the difficulties in endoscopic maneuverability, remain aware of the increased risk of complications, and then select the appropriate treatment according to the advantages and disadvantages of each method.
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Affiliation(s)
- Zheng Zhao
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing100050, China
| | - Yue Jiao
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing100050, China
| | - Shuyue Yang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing100050, China
| | - Anni Zhou
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing100050, China
| | - Guiping Zhao
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing100050, China
| | - Shuilong Guo
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing100050, China
| | - Peng Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing100050, China
| | - Shutian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing100050, China
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28
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Hayashi H, Miyamoto H, Nakagawa S, Matsuno K, Miyata T, Tsukamoto M, Mima K, Nitta H, Tanaka Y, Baba H. Distinct approaches (antecolic and retrocolic) according to tumor location in laparoscopic and endoscopic cooperative surgery for non-ampullary duodenum tumors. Surg Endosc 2023; 37:6718-6726. [PMID: 37217687 DOI: 10.1007/s00464-023-10114-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/03/2023] [Indexed: 05/24/2023]
Abstract
AIM Laparoscopic and endoscopic cooperative surgery for early non-ampullary duodenum tumors (D-LECS) is now noted because of its safety and lower invasiveness. Here, we introduce two distinct approaches (antecolic and retrocolic) according to the tumor location during D-LECS. METHODS From October 2018 to March 2022, 24 patients (25 lesions) underwent D-LECS. Two (8%), two (8%), 16 (64%), and five (20%) lesions were located in the first portion, in the second portion to Vater's papilla, around the inferior duodenum flexure, and in the third portion of the duodenum, respectively. The median preoperative tumor diameter was 22.5 mm. RESULTS Antecolic and retrocolic approaches were employed in 16 (67%) and 8 (33%) cases, respectively. LECS procedures, such as two-layer suturing after full-thickness dissection and laparoscopic reinforcement by seromuscular suturing after endoscopic submucosal dissection (ESD), were performed in five and 19 cases, respectively. Median operative time and blood loss were 303 min and 5 g, respectively. Intraoperative duodenal perforations occurred in three of 19 cases during ESD; however, they were successfully laparoscopically repaired. Median times until start diet and postoperative hospital stay were 4.5 and 8 days, respectively. Histological examination of the tumors revealed nine adenomas, 12 adenocarcinomas, and four GISTs. Curative resection (R0) was achieved in 21 cases (87.5%). In a comparison of the surgical short outcomes between antecolic and retrocolic approaches, there was no significant difference. CONCLUSION D-LECS can be a safe and minimally invasive treatment option for non-ampullary early duodenal tumors, and two distinct approaches according to the tumor location are feasible.
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Affiliation(s)
- Hiromitsu Hayashi
- Department of Gastroenterological Surgery, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
| | - Hideaki Miyamoto
- Department of Gastroenterology, Kumamoto University, Kumamoto, Japan
| | - Shigeki Nakagawa
- Department of Gastroenterological Surgery, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Kenshi Matsuno
- Department of Gastroenterology, Kumamoto University, Kumamoto, Japan
| | - Tatsunori Miyata
- Department of Gastroenterological Surgery, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Masayo Tsukamoto
- Department of Gastroenterological Surgery, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Kosuke Mima
- Department of Gastroenterological Surgery, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Hidetoshi Nitta
- Department of Gastroenterological Surgery, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Yasuhito Tanaka
- Department of Gastroenterology, Kumamoto University, Kumamoto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
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29
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Sawada A, Hirasawa K, Sato C, Sato S, Sato T, Sugimori K, Kunisaki C, Maeda S. Endoscopic Resection with One-Port Placement: A Newly Developed Technique for the Safe Management of Advanced Endoscopic Resection for Gastric Gastrointestinal Stromal Tumors. Digestion 2023; 104:460-467. [PMID: 37647880 DOI: 10.1159/000532012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 07/05/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Endoscopic full-thickness resection (EFTR) without laparoscopic assistance (pure EFTR) is an emerging, less invasive treatment for gastrointestinal stromal tumors (GISTs). However, the technique has seldom been performed outside China because of concerns regarding pneumoperitoneum, maintenance of endoscopic view, and endoscopic suturing. This study aimed to evaluate the efficacy and safety of endoscopic resection with one-port placement (EROPP) for gastric GISTs. METHODS This retrospective study included 17 patients with gastric GISTs originating from the muscularis propria who underwent EROPP between 2019 and 2022. One camera port was inserted in the umbilicus before initiating the endoscopic procedure to maintain intra-abdominal pressure, which was monitored and adjusted via this port. While allowing for conversion to laparoscopic surgery if needed, EFTR was performed as follows: (1) circumferential incision of the mucosal and submucosal layers around the lesion was performed by typical endoscopic submucosal dissection; (2) an intentional perforation and subsequent seromuscular resection was made using dental floss and an endo-clip for traction; and (3) closure of the gastric full-thickness defect was performed with an over-the-scope clip (OTSC) after peroral retrieval of the specimen. We retrospectively assessed the short-term outcomes and safety. RESULTS All procedures were completed successfully without conversion to laparoscopic surgery. The median size of the resected tumors was 23 mm (range, 8-35 mm), the median resection time was 36 min (range, 22-95 min), and closure time was 18 min (range, 10-45 min). The rates of en bloc and complete resection were 100% and 88%, respectively. In 2 cases, another port was added to aspirate the leaking fluid or check the condition of the endoscopic closure. All gastric defects were endoscopically closed, mainly using OTSCs. The recovery course for all patients was uneventful, and no adverse events were reported. CONCLUSIONS EROPP is a safe and minimally invasive treatment for gastric GISTs and appears to be suitable for introducing EFTR procedures.
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Affiliation(s)
- Atsushi Sawada
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Kingo Hirasawa
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Chiko Sato
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Sho Sato
- Department of Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Tsutomu Sato
- Department of Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazuya Sugimori
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Chikara Kunisaki
- Department of Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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30
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Chang WJ, Tsao LC, Yen HH, Yang CW, Chang HC, Kor CT, Wu SC, Lin KH. Goldilocks principle of minimally invasive surgery for gastric subepithelial tumors. World J Gastrointest Surg 2023; 15:1629-1640. [PMID: 37701681 PMCID: PMC10494604 DOI: 10.4240/wjgs.v15.i8.1629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/06/2023] [Accepted: 07/04/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Minimally invasive surgery had been tailored to individual cases of gastric subepithelial tumors (SETs) after comparing the clinical outcomes of endoscopic resection (ER), laparoscopic resection (LR), and hybrid methods. AIM To study the use of Goldilocks principle to determine the best form of minimally invasive surgery for gastric SETs. METHODS In this retrospective study, 194 patients of gastric SETs with high probability of surgical intervention were included. All patients underwent tumor resection in the operating theater between January 2013 and December 2021. The patients were divided into two groups, ER or LR, according to the tumor characteristics and the initial intent of intervention. Few patients in the ER group required further backup laparoscopic surgery after an incomplete ER. The patients who had converted open surgery were excluded. A logistic regression model was used to assess the associations between patient characteristics and the likelihood of a treatment strategy. The area under the curve was used to assess the discriminative ability of tumor size and Youden's index to determine the optimal cut-off tumor size. RESULTS One-hundred ninety-four patients (100 in the ER group and 94 in the LR group) underwent tumor resection in the operating theater. In the ER group, 27 patients required backup laparoscopic surgery after an incomplete ER. The patients in the ER group had small tumor sizes and shorter procedure durations while the patients in the LR group had large tumor sizes, exophytic growth, malignancy, and tumors that were more often located in the middle or lower third of the stomach. Both groups had similar durations of hospital stays and a similar rate of major postoperative complications. The patients in the ER group who underwent backup surgery required longer procedures (56.4 min) and prolonged stays (2 d) compared to the patients in the LR group without the increased rate of major postoperative complications. The optimal cut-off point for the tumor size for laparoscopic surgery was 2.15 cm. CONCLUSION Multidisciplinary teamwork leads to the adoption of different strategies to yield efficient clinical outcomes according to the tumor characteristics.
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Affiliation(s)
- Wei-Jung Chang
- Department of General Surgery, Changhua Christian Hospital, Changhua 50006, Taiwan
| | - Lien-Cheng Tsao
- Department of General Surgery, Changhua Christian Hospital, Changhua 50006, Taiwan
| | - Hsu-Heng Yen
- Department of Gastroenterology, Changhua Christian Hospital, Changhua 50006, Taiwan
- General Education Center, Chienkuo Technology University, Changhua 50006, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Chia-Wei Yang
- Department of Gastroenterology, Changhua Christian Hospital, Changhua 50006, Taiwan
| | - Hung-Chi Chang
- Department of General Surgery, Changhua Christian Hospital, Changhua 50006, Taiwan
| | - Chew-Teng Kor
- Big Data Center, Changhua Christian Hospital, Changhua 50006, Taiwan
- Graduate Institute of Statistics and Information Science, National Changhua University of Education, Changhua 50007, Taiwan
| | - Szu-Chia Wu
- Transplant Medicine & Surgery Research Center, Changhua Christian Hospital, Changhua 50006, Taiwan
| | - Kuo-Hua Lin
- Department of General Surgery, Changhua Christian Hospital, Changhua 50006, Taiwan
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Crafa F, Vanella S, Morante A, Catalano OA, Pomykala KL, Baiamonte M, Godas M, Antunes A, Costa Pereira J, Giaccaglia V. Non-exposed endoscopic wall-inversion surgery with one-step nucleic acid amplification for early gastrointestinal tumors: Personal experience and literature review. World J Gastroenterol 2023; 29:3883-3898. [PMID: 37426319 PMCID: PMC10324533 DOI: 10.3748/wjg.v29.i24.3883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/11/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Laparoscopic and endoscopic cooperative surgery is a safe, organ-sparing surgery that achieves full-thickness resection with adequate margins. Recent studies have demonstrated the safety and efficacy of these procedures. However, these techniques are limited by the exposure of the tumor and mucosa to the peritoneal cavity, which could lead to viable cancer cell seeding and the spillage of gastric juice or enteric liquids into the peritoneal cavity. Non-exposed endoscopic wall-inversion surgery (NEWS) is highly accurate in determining the resection margins to prevent intraperitoneal contamination because the tumor is inverted into the visceral lumen instead of the peritoneal cavity. Accurate intraoperative assessment of the nodal status could allow stratification of the extent of resection. One-step nucleic acid amplification (OSNA) can provide a rapid method of evaluating nodal tissue, whilst near-infrared laparoscopy together with indocyanine green can identify relevant nodal tissue intraoperatively.
AIM To determine the safety and feasibility of NEWS in early gastric and colon cancers and of adding rapid intraoperative lymph node (LN) assessment with OSNA.
METHODS The patient-based experiential portion of our investigations was conducted at the General and Oncological Surgery Unit of the St. Giuseppe Moscati Hospital (Avellino, Italy). Patients with early-stage gastric or colon cancer (diagnosed via endoscopy, endoscopic ultrasound, and computed tomography) were included. All lesions were treated by NEWS procedure with intraoperative OSNA assay between January 2022 and October 2022. LNs were examined intraoperatively with OSNA and postoperatively with conventional histology. We analyzed patient demographics, lesion features, histopathological diagnoses, R0 resection (negative margins) status, adverse events, and follow-up results. Data were collected prospectively and analyzed retrospectively.
RESULTS A total of 10 patients (5 males and 5 females) with an average age of 70.4 ± 4.5 years (range: 62-78 years) were enrolled in this study. Five patients were diagnosed with gastric cancer. The remaining 5 patients were diagnosed with early-stage colon cancer. The mean tumor diameter was 23.8 ± 11.6 mm (range: 15-36 mm). The NEWS procedure was successful in all cases. The mean procedure time was 111.5 ± 10.7 min (range: 80-145 min). The OSNA assay revealed no LN metastases in any patients. Histologically complete resection (R0) was achieved in 9 patients (90.0%). There was no recurrence during the follow-up period.
CONCLUSION NEWS combined with sentinel LN biopsy and OSNA assay is an effective and safe technique for the removal of selected early gastric and colon cancers in which it is not possible to adopt conventional endoscopic resection techniques. This procedure allows clinicians to acquire additional information on the LN status intraoperatively.
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Affiliation(s)
- Francesco Crafa
- Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
| | - Serafino Vanella
- Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
| | - Aristide Morante
- Division of Gastorenterology and Endoscopy, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
| | - Onofrio A Catalano
- Department of Radiology, Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
| | - Kelsey L Pomykala
- Department of Nuclear Medicine, Department of Radiological Sciences, University Hospital Essen, University of Duisburg-Essen, Essen 45141, Germany
| | - Mario Baiamonte
- Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
| | - Maria Godas
- Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
| | - Alexandra Antunes
- Department of General Surgery, Braga Hospital, Braga 4710-243, Portugal
| | | | - Valentina Giaccaglia
- Department of Surgery, Medclinic City Hospital, Dubai 505004, United Arab Emirates
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Honjo S, Yamauchi S, Yoshimoto Y, Jun C, Egawa H, Kubota A, Tsuda K, Yube Y, Kaji S, Orita H, Fukunaga T. A vanished gastric gastrointestinal stromal tumor. Surg Case Rep 2023; 9:92. [PMID: 37254018 DOI: 10.1186/s40792-023-01674-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 05/18/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Local resection is the standard treatment for gastrointestinal stromal tumors (GISTs). Laparoscopic and endoscopic cooperative surgery (LECS) is a minimally invasive surgery used to resect GISTs. Herein, we report an extremely rare case of a gastric GIST that grossly vanished during LECS. CASE PRESENTATION A 50-year-old Japanese female was referred to our hospital after an abnormality was detected during an esophagogastroduodenoscopy (EGD) at her annual health checkup. Based on EGD, endoscopic ultrasound (EUS), and computer tomography (CT) findings, the patient was diagnosed with a 50-mm submucosal tumor (SMT) with intraluminal growth on the anterior wall of the lesser curvature of the upper body of the stomach. We routinely use LECS to treat the intraluminal growth type of GISTs. During the intraoperative endoscopy, the intraluminal submucosal tumor, which was detected preoperatively, had vanished. A red-white scar was observed in the regressed tumor region. LECS was performed by resecting at a distance away from the scar tissue and closing the gastric wall with intracavitary sutures. In the evaluation from the tumor section view of the original resected specimen, a 22 × 14 × 8 mm lobular neoplasm was observed that was predominantly located in the gastric submucosa to the muscularis propia. Pathological findings confirmed the diagnosis of GIST with intermediate risk indicated by the Fletcher classification. The patient continued postoperative adjuvant chemotherapy with imatinib and no recurrence was detected over 12 months after surgery. CONCLUSION LECS was performed on the vanished gastric GIST, providing the best surgical treatment and leading to an accurate diagnosis and optimal postoperative care.
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Affiliation(s)
- Sarah Honjo
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Suguru Yamauchi
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan.
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
| | - Yutaro Yoshimoto
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Chen Jun
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Hiroki Egawa
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Akira Kubota
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Kenki Tsuda
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Yukinori Yube
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Sanae Kaji
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Hajime Orita
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Tetsu Fukunaga
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
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Yasuda A, Kimura Y, Shiraishi O, Shinkai M, Imano M, Yasuda T. A case of a gastric gastrointestinal stromal tumor in the esophagogastric junction successfully treated by laparoscopic intragastric resection. Int J Surg Case Rep 2023; 106:108156. [PMID: 37054541 PMCID: PMC10123243 DOI: 10.1016/j.ijscr.2023.108156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/15/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Laparoscopic wedge resection has been widely performed for gastric gastrointestinal stromal tumors (GISTs). However, because GISTs in the esophagogastric junction (EGJ) are prone to deformity and postoperative functional disorders, laparoscopic resection is technically very difficult and rarely reported. Herein, we report a case of a GIST in the EGJ successfully treated by laparoscopic intragastric surgery (IGS). CASE PRESENTATION A 58-year-old man with a GIST, which was intragastric growth type, 2.5 cm in diameter, located in the EGJ, and confirmed by upper gastrointestinal endoscope and endoscopic ultrasound-guided fine needle aspiration biopsy. We successfully performed IGS and the patient was discharged without complications. CLINICAL DISCUSSION Using laparoscopic wedge resection by exogastric approach, it is problematic to resect a gastric SMT located at the EGJ because of the difficulty in viewing the surgical field and additional concerns of deformation of the EGJ. We suppose IGS as a suitable method for such tumors. CONCLUSION Laparoscopic IGS for gastric GIST was useful in terms of safety and convenience even though the tumor was in the ECJ.
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Affiliation(s)
- Atsushi Yasuda
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, Osaka 589-8511, Japan.
| | - Yutaka Kimura
- Kindai Nara Hospital, 1248-1 Otoda-cho, Ikoma, Nara 630-0293, Japan
| | - Osamu Shiraishi
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, Osaka 589-8511, Japan
| | - Masayuki Shinkai
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, Osaka 589-8511, Japan
| | - Motohiro Imano
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, Osaka 589-8511, Japan
| | - Takushi Yasuda
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, Osaka 589-8511, Japan
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Kashima H, Kikuchi S, Kuroda S, Fujiwara T. Laparoscopic and Endoscopic Cooperative Surgery for Gastric Submucosal Tumor Near Esophagogastric Junction With Sliding Hiatal Hernia. Cureus 2023; 15:e37902. [PMID: 37223198 PMCID: PMC10202676 DOI: 10.7759/cureus.37902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 05/25/2023] Open
Abstract
The usefulness of laparoscopic and endoscopic cooperative surgery (LECS) for gastric submucosal tumors in the cardiac region has been reported in recent years. However, LECS for submucosal tumors at the esophagogastric junction with hiatal sliding esophageal hernia has not been reported, and its validity as a treatment method is unknown. The patient was a 51-year-old man with a growing submucosal tumor in the cardiac region. Surgical resection was indicated because a definitive diagnosis of the tumor was not determined. The lesion was a luminal protrusion tumor, located on the posterior wall of the stomach 20 mm from the esophagogastric junction, and had a maximum diameter of 16.3 mm on endoscopic ultrasound examination. Because of the hiatal hernia, the lesion could not be detected from the gastric side by endoscopy. Local resection was considered to be feasible because the resection line did not extend into the esophageal mucosa and the resection site could be less than half the circumference of the lumen. The submucosal tumor was resected completely and safely by LECS. The tumor was diagnosed as a gastric smooth muscle tumor finally. Nine months after surgery, a follow-up endoscopy showed reflux esophagitis. LECS was a useful technique for submucosal tumors of the cardiac region with hiatal hernia, but fundoplication might be considered for preventing backflow of gastric acid.
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Affiliation(s)
- Hajime Kashima
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
| | - Satoru Kikuchi
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
| | - Shinji Kuroda
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
| | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
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35
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Kar M, Singh A, Swain JR, Muduly DK, Sultania M, Sethi SK, Mahapatra J, Baisakh MR, Mohakud S. Laparoendoscopic hybrid procedure - Oncologically safe and feasible option for gastrointestinal stromal tumours of the stomach. J Minim Access Surg 2023; 19:326-328. [PMID: 37056094 PMCID: PMC10246647 DOI: 10.4103/jmas.jmas_237_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 05/30/2022] [Accepted: 12/15/2022] [Indexed: 02/16/2023] Open
Abstract
Minimally invasive resection of gastrointestinal stromal tumours of the stomach is a feasible alternative to the traditional open approach, without the need for advanced laparoscopic training, as lymph node dissection is not necessary and excision with a negative margin is the only requirement. The loss of tactile feedback is a known drawback of laparoscopic surgery, causing difficulty in assessing the margin of resection. Earlier described laparoendoscopic techniques require advanced endoscopic procedures, which are not readily available in all places. We present a novel method wherein we use an endoscope to guide the resection margins during laparoscopic surgery. In our experience of five patients, we were able to successfully use this technique to get the negative margins pathologically. This hybrid procedure can thus be used to ensure adequate margin, keeping all the benefits of laparoscopic surgery.
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Affiliation(s)
- Madhabananda Kar
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Abhitesh Singh
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Jyoti Ranjan Swain
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Dillip Kumar Muduly
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Mahesh Sultania
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sushant Kumar Sethi
- Department of Gastroenterology, Apollo Hospitals, Bhubaneswar, Odisha, India
| | | | | | - Sudipta Mohakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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36
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Teng TZJ, Ishraq F, Chay AFT, Tay KV. Lap-Endo cooperative surgery (LECS) in gastric GIST: updates and future advances. Surg Endosc 2023; 37:1672-1682. [PMID: 36220988 DOI: 10.1007/s00464-022-09691-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 09/25/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND With advancements in the field of laparoscopic and endoscopic techniques leading to improved patient outcomes, open resection has become increasingly outdated for the treatment of gastric gastrointestinal stromal tumours (GIST). This is further superseded with the advent of laparoscopic and endoscopic cooperative surgery (LECS), an amalgamation of the two techniques to further improve results garnered while overcoming prior limitations each had individually. METHODS The electronic databases MEDLINE, Embase and PubMed were reviewed up to August 2021, using terms relating to LECS and gastric GIST. Relevant in-article references not returned in the searches were also considered. RESULTS Advancements in the field of laparoscopic and endoscopic techniques has led to improved patient outcomes, making open resection a thing of the past for gastric GIST. This has become even more apparent with the advent of LECS, coupling two cutting edge techniques to further improve results garnered while overcoming prior limitations each had individually. LECS has gained much favour by reducing surgical margins due to endoscopic visualisation without being limited to smaller tumours, allowing for better anatomical and functional preservation of prior anatomy. Furthermore, hybrid approaches have improved perioperative outcomes, with reduction in procedure time, post-procedure hospital stay and lesser complications. Additionally, subtypes of LECS such as inverted LECS, closed LECS, non-exposed endoscopic wall-inversion surgery (NEWS) and laparoscopy-assisted endoscopic full-thickness resection (LAEFR) have been developed that allows the abdominal cavity to not be exposed to tumour cells and gastric contents by extracting the lesion transorally. CONCLUSIONS LECS and its subtypes being a combination of two advanced techniques shows a synergistic effect that is promising. However, despite all these advantages of enhanced safety and certainty, there remains areas that require further improvement.
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Affiliation(s)
- Thomas Zheng Jie Teng
- General Surgery, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore.
- Undergraduate Medicine, Lee Kong Chian School of Medicine, Singapore, 308232, Singapore.
| | - Farhan Ishraq
- Undergraduate Medicine, Lee Kong Chian School of Medicine, Singapore, 308232, Singapore
| | - Amelia Fang Ting Chay
- Undergraduate Medicine, Lee Kong Chian School of Medicine, Singapore, 308232, Singapore
| | - Kon Voi Tay
- General Surgery, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore
- General Surgery, Woodlands Health Campus, 2 Yishun Central, Singapore, 768024, Singapore
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Matsui T, Kobara H, Nishiyama N, Nakatani K, Shi T, Tada N, Kozuka K, Kobayashi N, Chiyo T, Yachida T, Kondo A, Kishino T, Okano K, Fujihara S, Uchita K, Hirasawa K, Masaki T. Comparison of purse-string suture versus over-the-scope clip for gastric endoscopic full-thickness closure: traction and leak pressure testing in ex vivo porcine model. BMC Surg 2023; 23:20. [PMID: 36703127 PMCID: PMC9878917 DOI: 10.1186/s12893-023-01920-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 01/18/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The recently developed endoscopic full-thickness resection technique requires reliable closure. The main closure methods are the purse-string suture (PSS) technique and over-the-scope clip (OTSC) technique; however, basic data on the closure strength of each technique are lacking. This study was performed to compare the closure strengths of these two methods in an ex vivo porcine model. METHODS In the traction test, a virtual 5-cm full-thickness closure line was closed by the following six methods three times each: conventional hemoclips, mucosal PSS, seromuscular PSS, mucosal OTSC, seromuscular OTSC, and surgical suture. The primary endpoint was the tension at the starting point of dehiscence, measured in Newtons (N) by an automatic traction machine. In the leak test, a 15-mm gastric full-thickness defect was closed by PSS or OTSC six times each, and the closed stomach was then pressurized in a water container. The primary endpoint was the leak pressure when air bubbles appeared. The secondary endpoints were the procedure time and presence of complete inverted closure. RESULTS The mean tension was 2.16, 3.68, 5.15, 18.30, 19.30, and 62.40 N for conventional hemoclips, mucosal PSS, seromuscular PSS, mucosal OTSC, seromuscular OTSC, and surgical suture, respectively. Complete inverted closure was observed for seromuscular PSS, seromuscular OTSC, and surgical suture. The mean leak pressure was 13.7 and 24.8 mmHg in the PSS and OTSC group, respectively (P < 0.01). The mean procedure time was 541 and 169 s in the PSS and OTSC group, respectively (P < 0.01). Complete inverted closure was observed in OTSC alone. CONCLUSION The OTSC, which allows complete inverted closure, showed greater closure strength than PSS. Considering the size limitation suitable for single OTSC, a therapeutic strategy for closing the larger size is further warranted.
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Affiliation(s)
- Takanori Matsui
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Kita, Miki, Kagawa, 761-0793, Japan.
| | - Hideki Kobara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Kita, Miki, Kagawa, 761-0793, Japan
| | - Noriko Nishiyama
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Kita, Miki, Kagawa, 761-0793, Japan
| | - Kaho Nakatani
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Kita, Miki, Kagawa, 761-0793, Japan
| | - Tingting Shi
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Kita, Miki, Kagawa, 761-0793, Japan
| | - Naoya Tada
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Kita, Miki, Kagawa, 761-0793, Japan
| | - Kazuhiro Kozuka
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Kita, Miki, Kagawa, 761-0793, Japan
| | - Nobuya Kobayashi
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Kita, Miki, Kagawa, 761-0793, Japan
| | - Taiga Chiyo
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Kita, Miki, Kagawa, 761-0793, Japan
| | - Tatsuo Yachida
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Kita, Miki, Kagawa, 761-0793, Japan
| | - Akihiro Kondo
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kita, Japan
| | - Takayoshi Kishino
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kita, Japan
| | - Keiichi Okano
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kita, Japan
| | - Shintaro Fujihara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Kita, Miki, Kagawa, 761-0793, Japan
| | - Kunihisa Uchita
- Department of Gastroenterology, Kochi Red Cross Hospital, Kochi, Japan
| | - Kingo Hirasawa
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Tsutomu Masaki
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Kita, Miki, Kagawa, 761-0793, Japan
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Núñez-Rocha RE, Pérez V, Urango ML, Latiff M, Pinto R, Herrera-Almario G. Laparoendoscopic assisted surgery for a gastrointestinal stromal tumor (GIST): A case report. Int J Surg Case Rep 2023; 102:107871. [PMID: 36608632 PMCID: PMC9826923 DOI: 10.1016/j.ijscr.2022.107871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/29/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Gastrointestinal stromal tumors (GIST) are infrequent, and clinical presentation varies between asymptomatic and diffuse symptoms such as abdominal pain and dyspepsia. Surgical approach depends on location and size of the tumor. There are some reports of the specific surgical approach for GIST located at the gastroesophageal junction. This is a case report of a patient with a GIST located specifically at the gastroesophageal junction and the surgical approach selected for the treatment. PRESENTATION OF THE CASE A 70-year-old patient who developed an episode of upper gastrointestinal bleeding with hemorrhagic shock accompanied by elevated troponins that required transfusion therapy and whose endoscopic evaluation showed a subcardial ulcerated lesion of 16 × 5 mm, located 2 cm below the z-line. The lesion was biopsied and was negative for malignancy. A combined surgical approach for resection by combined laparoscopy and submucosal resection by upper gastrointestinal endoscopy was performed by the interventional gastroenterology service and surgical oncology service. DISCUSSION Specific management of GISTs depends on the location of the tumor, even though, complete surgical resection remains the gold standard treatment. Minimally invasive techniques can be used to assess these tumors leading to shorter hospital stays and lesser risk of complications. Laparoendoscopic cooperative surgery is a promising approach for managing lesions near the gastroesophageal junction. CONCLUSION GISTs located near the gastroesophageal junction require a complex approach. The laparaendoscopic approach seems to be a feasible approach for GIST in the gastroesophageal junction.
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Affiliation(s)
- Ricardo E. Núñez-Rocha
- School of Medicine, Universidad de los Andes, Bogotá, Colombia,Corresponding author at: School of Medicine, Universidad de los Andes, Calle 119 no 7-14, Bogotá D.C 110111, Colombia.
| | - Valentina Pérez
- School of Medicine, Universidad de los Andes, Bogotá, Colombia
| | | | - Mario Latiff
- School of Medicine, Universidad de los Andes, Bogotá, Colombia
| | - Renzo Pinto
- School of Medicine, Universidad de los Andes, Bogotá, Colombia,Department of Gastroenterology, Fundación Santa Fe de Bogotá, Colombia
| | - Gabriel Herrera-Almario
- School of Medicine, Universidad de los Andes, Bogotá, Colombia,Department of Surgery, Fundación Santa Fe de Bogotá, Colombia
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Iijima Y, Tokumaru S, Kitazawa M, Nakamura S, Koyama M, Yamamoto Y, Ehara T, Hondo N, Miyazaki S, Soejima Y. Gastric glomus tumor resection using laparoscopic endoscopic cooperative surgery: A case report. Asian J Endosc Surg 2023. [PMID: 36592948 DOI: 10.1111/ases.13153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 11/25/2022] [Accepted: 12/03/2022] [Indexed: 01/04/2023]
Abstract
Gastric glomus tumors are rare submucosal mesenchymal neoplasms that are difficult to diagnose preoperatively. We present a case of a 60-year-old woman who was diagnosed with a gastric glomus tumor using endoscopic ultrasonography-guided fine-needle aspiration biopsy. The tumor was successfully resected with laparoscopic endoscopic cooperative surgery (LECS). LECS could be an effective method for the resection of gastric glomus tumors.
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Affiliation(s)
- Yasuhiro Iijima
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shigeo Tokumaru
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masato Kitazawa
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Satoshi Nakamura
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Makoto Koyama
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuta Yamamoto
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takehito Ehara
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Nao Hondo
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Satoru Miyazaki
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuji Soejima
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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Yip HC, Teh JL, Teoh AYB, Chiu P. Pure endoscopic resection versus laparoscopic assisted procedure for upper gastrointestinal stromal tumors: Perspective from a surgical endoscopist. Dig Endosc 2023; 35:184-194. [PMID: 36318279 DOI: 10.1111/den.14463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/31/2022] [Indexed: 11/27/2022]
Abstract
Management of upper gastrointestinal (UGI) tract gastrointestinal stromal tumor (GIST) has evolved significantly over the past two decades. For GIST size smaller than 5 cm, laparoscopic resection has become the current standard. To avoid postoperative gastric deformity and preserve gastric function, laparoscopic endoscopic cooperative surgery (LECS) was developed and various modifications have been reported and utilized successfully. Pure endoscopic resection techniques have also been reported at a similar period of time, which further push the boundary of incisionless surgery in managing these lesions. Both tunneling and nontunneling exposed type endoscopic full thickness resection are well described procedures for resection of small UGI GIST. In this review, a summary of these procedures is provided, and the pros and cons of each technique from the perspective of a surgical endoscopist are discussed in detail. LECS and endoscopic resection are complementary to each other. The choice of technique should be tailored to the location, morphology, and size of the target lesions, taking into account the experience of the laparoscopic surgeons and endoscopists.
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Affiliation(s)
- Hon Chi Yip
- Division of Upper Gastrointestinal and Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jun Liang Teh
- Division of Upper Gastrointestinal and Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.,National University Health System, Singapore City, Singapore
| | - Anthony Y B Teoh
- Division of Upper Gastrointestinal and Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Philip Chiu
- Division of Upper Gastrointestinal and Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Yue L, Sun Y, Wang X, Hu W. Advances of endoscopic and surgical management in gastrointestinal stromal tumors. Front Surg 2023; 10:1092997. [PMID: 37123546 PMCID: PMC10130460 DOI: 10.3389/fsurg.2023.1092997] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/24/2023] [Indexed: 05/02/2023] Open
Abstract
As one of the most common mesenchymal malignancies in the digestive system, gastrointestinal stromal tumors (GISTs) occur throughout the alimentary tract with diversified oncological characteristics. With the advent of the tyrosine kinase inhibitor era, the treatment regimens of patients with GISTs have been revolutionized and GISTs have become the paradigm of multidisciplinary therapy. However, surgery resection remains recognized as the potentially curative management for the radical resection and provided with favorable oncological outcomes. The existing available surgery algorithms in clinical practice primarily incorporate open procedure, and endoscopic and laparoscopic surgery together with combined operation techniques. The performance of various surgery methods often refers to the consideration of risk evaluation of recurrence and metastases; the degree of disease progression; size, location, and growth pattern of tumor; general conditions of selected patients; and indications and safety profile of various techniques. In the present review, we summarize the fundamental principle of surgery of GISTs based on risk assessment as well as tumor size, location, and degree of progress with an emphasis on the indications, strengths, and limitations of current surgery techniques.
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Affiliation(s)
- Lei Yue
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, China
| | - Yingchao Sun
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, China
| | - Xinjie Wang
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, China
| | - Weiling Hu
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, China
- Institute of Gastroenterology, Zhejiang University (IGZJU), Hangzhou, China
- Zhejiang University Cancer Center, Hangzhou, China
- Correspondence: Weiling Hu
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Imamura S, Nakamura K, Takarabe S, Arahata K, Katayama T, Ojiro K, Kishikawa H, Sasaki A, Hasegawa H, Nishida J. A case of early gastric cancer resembling a subepithelial lesion diagnosed by endoscopic ultrasound-guided fine needle aspiration. Clin J Gastroenterol 2022; 15:1048-1054. [PMID: 36198987 DOI: 10.1007/s12328-022-01706-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/20/2022] [Indexed: 11/05/2022]
Abstract
We present a case of early gastric cancer resembling a subepithelial lesion (GCSEL) derived from the submucosal ectopic gastric glands (SEGGs), diagnosed using endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). A 55-year-old woman was referred to our hospital for the investigation of a subepithelial lesion (SEL). Contrast computed tomography and esophagogastroduodenoscopy revealed two SELs in the greater curvature of the fundus and the posterior wall of the upper body of the stomach. EUS revealed a hypoechoic lesion in the submucosa and suggested partial invasion into the muscularis propria of the greater curvature of the fundus, and an anechoic lesion in the submucosa of the posterior wall of the upper body. The different diagnosis for the SEL in the fundus was GCSEL, neuroendocrine tumor, malignant lymphoma, and gastric adenocarcinoma of fundic gland type. EUS-FNA findings suggested adenocarcinoma. The patient underwent a laparoscopic proximal gastrectomy. Pathological findings confirmed a differentiated tubular adenocarcinoma derived from the SEGG, which partially invaded into the submucosa of the surrounding gastric wall without lymphovascular invasion or lymph node metastasis. The patient has been recurrence-free after 10 months of follow-up. EUS should be performed for SELs followed by EUS-FNA for lesions, such as GCSEL, that require early intervention.
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Affiliation(s)
- Shunsuke Imamura
- Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Kenji Nakamura
- Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan.
| | - Sakiko Takarabe
- Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Kyoko Arahata
- Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Tadashi Katayama
- Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Keisuke Ojiro
- Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Hiroshi Kishikawa
- Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Aya Sasaki
- Department of Clinical Laboratory, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | - Hirotoshi Hasegawa
- Department of Surgery, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | - Jiro Nishida
- Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan
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Ishida S, Hirashita T, Kawano Y, Orimoto H, Amano S, Kawamura M, Fujinaga A, Kawasaki T, Masuda T, Endo Y, Ohta M, Inomata M. Pancreas-preserving partial duodenectomy for non-ampullary duodenal neoplasms: three case reports. Surg Case Rep 2022; 8:138. [PMID: 35871208 PMCID: PMC9308848 DOI: 10.1186/s40792-022-01489-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
There are multiple surgical procedures for resecting non-ampullary duodenal neoplasms (NADNs), and the appropriate method is selected depending on the tumor location and diagnosis. We herein report 3 cases of NADNs that were resected using pancreas-preserving partial duodenectomy (PPD).
Case reports
The first patient, a 73-year-old woman with a circumferential duodenal adenoma in the supra-ampullary duodenum, underwent surgery. After laparotomy, the duodenum proximal to the tumor was confirmed using intraoperative endoscopy and dissected. The duodenum distal to the tumor was dissected under direct visualization, and the specimen was removed. The distal stump of the duodenum was closed, and duodenojejunostomy was performed as described by Billroth II. The tumor was diagnosed as an adenoma 75 mm in size. She was discharged 12 days after surgery without any complications. The second patient, a 48-year-old man, was diagnosed with a neuroendocrine neoplasm (NEN) with a diameter of 14 mm in the supra-ampullary duodenum. Laparoscopic PPD was performed. He was diagnosed with NEN G1 and discharged the 11th day after surgery. The third patient, a 71-year-old man with a 0–Is + IIa lesion in the horizontal duodenum, underwent surgery. After laparotomy, the horizontal duodenum and proximal jejunum were resected, and duodenojejunostomy was performed. The patient was diagnosed with stage I adenocarcinoma and discharged on the 15th day after surgery.
Conclusion
PPD is useful for avoiding the morbidity of pancreatoduodenectomy in the management of NADNs without invasion to the ampulla of Vater or pancreas.
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Hu ZH, Li RX, Wang JT, Wang GJ, Deng XM, Zhu TY, Gao BL, Zhang YF. Thoracolaparoscopic esophagectomy for esophageal cancer with a cervical or abdominal incision to extract specimen. Medicine (Baltimore) 2022; 101:e31131. [PMID: 36316905 PMCID: PMC9622648 DOI: 10.1097/md.0000000000031131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Surgery is the only curative approach for resectable esophageal cancer. This retrospective study was to investigate the immediate effect and operative complications of conventional and modified thoracolaparoscopic esophagectomy with a cervical or abdominal incision to extract specimen for the treatment of patients with esophageal cancer. Eighty-one patients were enrolled, among which 55 patients underwent conventional McKeown thoracolaparoscopic esophagectomy (conventional MTE) and 26 patients underwent modified MTE with a cerivical incision (modified MTE). The clinical, surgical, and postoperative data were analyzed. No significant (P > .05) difference was detected in the clinical data between two groups. The surgical procedure was successful in all patients (100%). The surgical time was significantly (P = .018) shorter in the conventional MTE group than in the modified MTE group (280 min vs 317 min). However, no significant (P > .05) difference was found in blood loss (200 mL vs 180 mL), intensive care unit (ICU) stay (31.3 ± 11.3 vs 25.2 ± 6.4 hours), first flatus after surgery (2.9 ± 1.9 vs 3.3 ± 1.6 days), postoperative hospital stay (12.9 ± 5.6 vs 12.6 ± 3.3 days), total number of lymph nodes dissected (27.9 ± 4.1 vs 26.7 ± 5.7), types of carcinoma, and pathological classification. No significant (P > .05) differences were detected in postoperative complications between the two groups. Assessment of postoperative pain using the visual analogue scale (VAS) score showed a significant (P < .05) difference in the VAS score at day 2 (4.81 ± 1.70 vs 3.87 ± 1.14) and day 3 (5.10 ± 0.83 vs 4.61 ± 1.12) between the conventional and modified MTE groups. The modified McKeown thoracolaparoscopic esophagectomy with only one cervical incision is more minimally invasive, more cosmetic, and less painful than the conventional approach.
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Affiliation(s)
- Zhi-Hao Hu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Rui-Xin Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing-Tao Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guo-Jun Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Guo-Jun Wang, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou 450052, China (e-mail: )
| | - Xiu-Mei Deng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tian-Yu Zhu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bu-Lang Gao
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yun-Fei Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Zhao PY, Ma ZF, Jiao YN, Yan Y, Li SY, Du XH. Laparoscopic and endoscopic cooperative surgery for early gastric cancer: Perspective for actual practice. Front Oncol 2022; 12:969628. [PMID: 36263224 PMCID: PMC9574332 DOI: 10.3389/fonc.2022.969628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Early gastric cancer (EGC) has a desirable prognosis compared with advanced gastric cancer (AGC). The surgical concept of EGC has altered from simply emphasizing radical resection to both radical resection and functional preservation. As the mainstream surgical methods for EGC, both endoscopic resection and laparoscopic resection have certain inherent limitations, while the advent of laparoscopic and endoscopic cooperative surgery (LECS) has overcome these limitations to a considerable extent. LECS not only expands the surgical indications for endoscopic resection, but greatly improves the quality of life (QOL) in EGC patients. This minireview elaborates on the research status of LECS for EGC, from the conception and development of LECS, to the tentative application of LECS in animal experiments, then to case reports and retrospective clinical studies. Finally, the challenges and prospects of LECS in the field of EGC are prospected and expounded, hoping to provide some references for relevant researchers. With the in-depth understanding of minimally invasive technology, LECS remains a promising option in the management of EGC. Carrying out more related multicenter prospective clinical researches is the top priority of promoting the development of this field in the future.
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Affiliation(s)
| | | | | | | | | | - Xiao-hui Du
- *Correspondence: Xiao-hui Du, ; Peng-yue Zhao,
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Issues and Prospects of Current Endoscopic Treatment Strategy for Superficial Non-Ampullary Duodenal Epithelial Tumors. Curr Oncol 2022; 29:6816-6825. [PMID: 36290814 PMCID: PMC9600730 DOI: 10.3390/curroncol29100537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/11/2022] [Accepted: 09/20/2022] [Indexed: 01/13/2023] Open
Abstract
An increasing number of duodenal tumors are being diagnosed over the years, leading to increased confusion regarding the choice of treatment options. Small-to-large tumors and histological types vary from adenoma to carcinoma, and treatment methods may need to be selected according to lesion characteristics. Because of its anatomic characteristics, complications are more likely to occur in the duodenum than in other gastrointestinal organs. Several reports have described the outcomes of conventional endoscopic mucosal resection, endoscopic submucosal dissection, cold snare polypectomy, underwater endoscopic mucosal resection, endoscopic full-thickness resection, and laparoscopic and endoscopic cooperative surgery for duodenal tumors. However, even in the guidelines set out by various countries, only the treatment methods are listed, and no clear treatment strategies are provided. Although there are few reports with a sufficiently high level of evidence, considering the currently available treatment options is essential. In this report, we reviewed previous reports on each treatment strategy, discussed the current issues and prospects, and proposed the best possible treatment strategy.
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Harada H, Ohashi M, Hiki N, Fujisaki J, Hirasawa T, Yamamoto Y, Makuuchi R, Ida S, Hayami M, Kumagai K, Sano T, Nunobe S. Excellent oncological outcomes besides short-term safety of laparoscopic and endoscopic cooperative surgery for gastric gastrointestinal stromal tumor. Endosc Int Open 2022; 10:E1254-E1260. [PMID: 36118650 PMCID: PMC9473822 DOI: 10.1055/a-1895-9507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/05/2022] [Indexed: 10/27/2022] Open
Abstract
Background and study aims Laparoscopic and endoscopic cooperative surgery (LECS) for gastric submucosal tumor was developed as a type of minimal local resection and is now widely used in Asian countries. However, the oncological safety of LECS for gastric gastrointestinal stromal tumor (GIST) remains unclear. LECS has potential oncology-related problems that may influence survival outcomes. Furthermore, the feasibility and safety of LECS have not yet been fully established. Patients and methods Patients who were intended to undergo LECS for gastric GIST from 2006 to 2020 were retrospectively selected. The indication for LECS was determined according to the guidelines. The completion of LECS, complications, and survival outcomes of the patients were analyzed. Results Two hundred fifty-nine patients were eligible in this study. According to intraoperative findings, 44 patients underwent local resection without luminal endoscopic procedures. Of the remaining 215 patients, 213 completely underwent LECS, which corresponds to a completion rate of 99.1 %. Six patients (2.8 %) had postoperative complications of Clavien-Dindo classification grade II or higher. Delayed gastric emptying was most commonly found in four patients (1.9 %). Old age ( P = 0.0349), female sex ( P = 0.0095), tumor located in the lesser curvature ( P = 0.0015), and large tumor diameter ( P = 0.0232) were significantly more common in patients with complications. The 3-year overall and disease-specific survival rates were 99 % and 100 %, respectively, in 215 patients who were intended to undergo LECS. Conclusions Despite several oncological concerns, LECS for gastric GIST is oncologically safe besides a feasible and safe procedure in the short-term.
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Affiliation(s)
- Hiroki Harada
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan,Department of Upper-gastrointestinal Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Manabu Ohashi
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Naoki Hiki
- Department of Upper-gastrointestinal Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Junko Fujisaki
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiaki Hirasawa
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yorimasa Yamamoto
- Division of Gastroenterology, Endoscopy Center, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Rie Makuuchi
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Satoshi Ida
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masaru Hayami
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Koshi Kumagai
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takeshi Sano
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Souya Nunobe
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Vanella S, Godas M, Pereira JC, Pereira A, Apicella I, Crafa F. Laparoscopic and endoscopic cooperative surgery for full-thickness resection and sentinel node dissection for early gastric cancer. World J Gastrointest Endosc 2022; 14:508-511. [PMID: 36158631 PMCID: PMC9453308 DOI: 10.4253/wjge.v14.i8.508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/28/2022] [Accepted: 07/18/2022] [Indexed: 02/05/2023] Open
Abstract
The endoscopic submucosal dissection (ESD) technique has become the gold standard for submucosal tumors that have negligible risk of lymph node metastasis (LNM), due to its minimal invasiveness and ability to improve quality of life. However, this technique is limited in stage T1 cancers that have a low risk of LNM. Endoscopic full thickness resection can be achieved with laparoscopic endoscopic cooperative surgery (LECS), which combines laparoscopic gastric wall resection and ESD. In LECS, the surgical margins from the tumor are clearly achieved while performing organ-preserving surgery. To overcome the limitation of classical LECS, namely the opening of the gastric wall during the procedure, which increases the risk of peritoneal tumor seeding, non-exposed endoscopic wall-inversion surgery was developed. With this full-thickness resection technique, contact between the intra-abdominal space and the intragastric space was eliminated.
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Affiliation(s)
- Serafino Vanella
- Department of General and Oncology Surgery, St. Giuseppe Moscati Hospital, Avellino 83100, Italy
| | - Maria Godas
- Department of General and Oncology Surgery, St. Giuseppe Moscati Hospital, Avellino 83100, Italy
| | | | - Ana Pereira
- Department of General and Oncology Surgery, St. Giuseppe Moscati Hospital, Avellino 83100, Italy
- Department of General Surgery, Hospital de Braga, Braga 4710-243, Portugal
| | - Ivano Apicella
- Department of General and Oncology Surgery, St. Giuseppe Moscati Hospital, Avellino 83100, Italy
| | - Francesco Crafa
- Department of General and Oncology Surgery, St. Giuseppe Moscati Hospital, Avellino 83100, Italy
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Abstract
Gastrointestinal stromal tumors (GISTs) are rare malignancies of the gastrointestinal tract but are the most common sarcoma. This review covers aspects of the care of patients with GIST relevant to surgeons. In particular, management of sub-2 cm GISTs, the utility of neoadjuvant and adjuvant therapy for primary GISTs, and indications for surgery in the setting of metastatic disease are discussed.
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Affiliation(s)
- Ilaria Caturegli
- Department of Surgery, Brigham and Women's Hospital, Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital, Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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Ortigão R, Libânio D, Dinis-Ribeiro M. The future of endoscopic resection for early gastric cancer. J Surg Oncol 2022; 125:1110-1122. [PMID: 35481914 DOI: 10.1002/jso.26851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 02/20/2022] [Indexed: 11/09/2022]
Abstract
Endoscopic resection for early gastric cancer is recommended when the risk of lymph node metastasis is negligible and should be performed through submucosal dissection due to well-established short- and long-term results. To overcome technical difficulties and decrease adverse events some techniques have been studied. This review outlines current strategies for improving patient selection and highlights innovative techniques that help minimize adverse events. Moreover, we discuss how to improve management after curative and noncurative resections.
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Affiliation(s)
- Raquel Ortigão
- Department of Gastroenterology, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Diogo Libânio
- Department of Gastroenterology, Portuguese Oncology Institute of Porto, Porto, Portugal
- CINTESIS (Center for Health Technology and Services Research), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Mário Dinis-Ribeiro
- Department of Gastroenterology, Portuguese Oncology Institute of Porto, Porto, Portugal
- CINTESIS (Center for Health Technology and Services Research), Faculty of Medicine, University of Porto, Porto, Portugal
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