DOI QR코드

DOI QR Code

Oncologic Safety of Laparoscopic Wedge Resection with Gastrotomy for Gastric Gastrointestinal Stromal Tumor: Comparison with Conventional Laparoscopic Wedge Resection

  • Lee, Sejin (Department of Surgery, Yonsei University College of Medicine) ;
  • Kim, You Na (Department of Surgery, Yonsei University College of Medicine) ;
  • Son, Taeil (Department of Surgery, Yonsei University College of Medicine) ;
  • Kim, Hyoung-Il (Department of Surgery, Yonsei University College of Medicine) ;
  • Cheong, Jae-Ho (Department of Surgery, Yonsei University College of Medicine) ;
  • Hyung, Woo Jin (Department of Surgery, Yonsei University College of Medicine) ;
  • Noh, Sung Hoon (Department of Surgery, Yonsei University College of Medicine)
  • 투고 : 2015.10.06
  • 심사 : 2015.10.19
  • 발행 : 2015.12.31

초록

Purpose: Various laparoscopic wedge resection (LWR) techniques requiring gastrotomy for gastrointestinal stromal tumors (GISTs) of the stomach have been applied to facilitate tumor resection and preserve the remnant gastric volume. However, there is the possibility of cancer cell dissemination during these procedures. The aim of this study was to assess the oncologic safety of LWR with gastrotomy (LWR-G) compared to LWR without luminal exposure. Materials and Methods: Clinicopathologic and operative results of 193 patients who underwent LWR for gastric GIST were retrospectively analyzed from 2003 to 2013. We stratified the patients into two groups: LWR-G and LWR without gastrotomy (LWR-C). Clinicopathologic features, short-term outcomes, and long-term outcomes were compared. Results: A total of 26 patients underwent LWR-G, and 167 patients underwent LWR-C. The LWR-G group showed significantly more anterior wall-located (n=10, 38.5%), intraluminal (n=20, 76.9%), and ulcerative (n=13, 50.0%) tumors than the LWR-C group (n=33, 19.8%; n=96, 57.5%; n=46, 27.5%, respectively). Postoperative short-term outcomes did not differ between the two groups. When tumor staging was compared, no statistical difference was noted. There was no recurrence in the LWR-G group, while 2 patients in the LWR-C group experienced recurrence. The two recurrences in the LWR-C group were found in the liver and in the remnant stomach at 63 and 12 months after the operation, respectively. No gastric GIST-related death was recorded in any group during the study period. Conclusions: LWR-G for gastric GIST is an oncologically safe procedure even for masses with ulcerations.

키워드

참고문헌

  1. Matthews BD, Joels CS, Kercher KW, Heniford BT. Gastrointestinal stromal tumors of the stomach. Minerva Chir 2004;59:219-231.
  2. Das A, Wilson R, Biankin AV, Merrett ND. Surgical therapy for gastrointestinal stromal tumours of the upper gastrointestinal tract. J Gastrointest Surg 2009;13:1220-1225. https://doi.org/10.1007/s11605-009-0885-8
  3. Pidhorecky I, Cheney RT, Kraybill WG, Gibbs JF. Gastrointestinal stromal tumors: current diagnosis, biologic behavior, and management. Ann Surg Oncol 2000;7:705-712. https://doi.org/10.1007/s10434-000-0705-6
  4. Emory TS, Sobin LH, Lukes L, Lee DH, O'Leary TJ. Prognosis of gastrointestinal smooth-muscle (stromal) tumors: dependence on anatomic site. Am J Surg Pathol 1999;23:82-87. https://doi.org/10.1097/00000478-199901000-00009
  5. Privette A, McCahill L, Borrazzo E, Single RM, Zubarik R. Laparoscopic approaches to resection of suspected gastric gastrointestinal stromal tumors based on tumor location. Surg Endosc 2008;22:487-494. https://doi.org/10.1007/s00464-007-9493-4
  6. DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 2000;231:51-58. https://doi.org/10.1097/00000658-200001000-00008
  7. Hassan I, You YN, Shyyan R, Dozois EJ, Smyrk TC, Okuno SH, et al. Surgically managed gastrointestinal stromal tumors: a comparative and prognostic analysis. Ann Surg Oncol 2008;15:52-59. https://doi.org/10.1245/s10434-007-9633-z
  8. Fowler DL, White SA. Laparoscopic resection of a submucosal gastric lipoma: a case report. J Laparoendosc Surg 1991;1:303-306. https://doi.org/10.1089/lps.1991.1.303
  9. Berindoague R, Targarona EM, Feliu X, Artigas V, Balague C, Aldeano A, et al. Laparoscopic resection of clinically suspected gastric stromal tumors. Surg Innov 2006;13:231-237. https://doi.org/10.1177/1553350606295960
  10. Nishida T, Hirota S, Yanagisawa A, Sugino Y, Minami M, Yamamura Y, et al; GIST Guideline Subcommittee. Clinical practice guidelines for gastrointestinal stromal tumor (GIST) in Japan: English version. Int J Clin Oncol 2008;13:416-430. https://doi.org/10.1007/s10147-008-0798-7
  11. Mochizuki Y, Kodera Y, Fujiwara M, Ito S, Yamamura Y, Sawaki A, et al. Laparoscopic wedge resection for gastrointestinal stromal tumors of the stomach: initial experience. Surg Today 2006;36:341-347. https://doi.org/10.1007/s00595-005-3164-7
  12. Choi YB, Oh ST. Laparoscopy in the management of gastric submucosal tumors. Surg Endosc 2000;14:741-745. https://doi.org/10.1007/s004640000148
  13. Basso N, Rosato P, De Leo A, Picconi T, Trentino P, Fantini A, et al. Laparoscopic treatment of gastric stromal tumors. Surg Endosc 2000;14:524-526. https://doi.org/10.1007/s004640000021
  14. Avital S, Brasesco O, Szomstein S, Liberman M, Rosenthal R. Technical considerations in laparoscopic resection of gastric neoplasms. Surg Endosc 2003;17:763-765. https://doi.org/10.1007/s00464-002-8585-4
  15. Hyung WJ, Lim JS, Cheong JH, Kim J, Choi SH, Noh SH. Laparoscopic resection of a huge intraluminal gastric submucosal tumor located in the anterior wall: eversion method. J Surg Oncol 2005;89:95-98. https://doi.org/10.1002/jso.20195
  16. Tangoku A, Yamamoto K, Hirazawa K, Takao T, Mori N, Tada K, et al. Laparoscopic resection of large leiomyomas of the gastric fundus. Surg Endosc 1999;13:1050-1052. https://doi.org/10.1007/s004649901168
  17. Novitsky YW, Kercher KW, Sing RF, Heniford BT. Long-term outcomes of laparoscopic resection of gastric gastrointestinal stromal tumors. Ann Surg 2006;243:738-745. https://doi.org/10.1097/01.sla.0000219739.11758.27
  18. Kiyozaki H, Saito M, Chiba H, Takata O, Rikiyama T. Laparoscopic wedge resection of the stomach for gastrointestinal stromal tumor (GIST): non-touch lesion lifting method. Gastric Cancer 2014;17:337-340. https://doi.org/10.1007/s10120-013-0272-8
  19. Motson RW, Fisher PW, Dawson JW. Laparoscopic resection of a benign intragastric stromal tumour. Br J Surg 1995;82:1670. https://doi.org/10.1002/bjs.1800821228
  20. Ibrahim IM, Silvestri F, Zingler B. Laparoscopic resection of posterior gastric leiomyoma. Surg Endosc 1997;11:277-279. https://doi.org/10.1007/s004649900343
  21. Hwang SH, Park do J, Kim YH, Lee KH, Lee HS, Kim HH, et al. Laparoscopic surgery for submucosal tumors located at the esophagogastric junction and the prepylorus. Surg Endosc 2009;23:1980-1987. https://doi.org/10.1007/s00464-008-9955-3
  22. Na JU, Lee SI, Noh SM. The single incision laparoscopic intragastric wedge resection of gastric submucosal tumor. J Gastric Cancer 2011;11:225-229. https://doi.org/10.5230/jgc.2011.11.4.225
  23. Choi CI, Lee SH, Hwang SH, Kim DH, Jeon TY, Kim DH, et al. Single-incision intragastric resection for upper and mid gastric submucosal tumors: a case-series study. Ann Surg Treat Res 2014;87:304-310. https://doi.org/10.4174/astr.2014.87.6.304
  24. Miettinen M, Majidi M, Lasota J. Pathology and diagnostic criteria of gastrointestinal stromal tumors (GISTs): a review. Eur J Cancer 2002;38 Suppl 5:S39-S51.
  25. Kim KH, Kim MC, Jung GJ, Kim SJ, Jang JS, Kwon HC. Long term survival results for gastric GIST: is laparoscopic surgery for large gastric GIST feasible? World J Surg Oncol 2012;10:230. https://doi.org/10.1186/1477-7819-10-230
  26. Honda M, Hiki N, Nunobe S, Ohashi M, Kiyokawa T, Sano T, et al. Long-term and surgical outcomes of laparoscopic surgery for gastric gastrointestinal stromal tumors. Surg Endosc 2014;28:2317-2322. https://doi.org/10.1007/s00464-014-3459-0
  27. Blay JY, Bonvalot S, Casali P, Choi H, Debiec-Richter M, Dei Tos AP, et al; GIST consensus meeting panelists. Consensus meeting for the management of gastrointestinal stromal tumors. Report of the GIST Consensus Conference of 20-21 March 2004, under the auspices of ESMO. Ann Oncol 2005;16:566-578. https://doi.org/10.1093/annonc/mdi127
  28. Demetri GD, Benjamin RS, Blanke CD, Blay JY, Casali P, Choi H, et al; NCCN Task Force. NCCN Task Force report: management of patients with gastrointestinal stromal tumor (GIST): update of the NCCN clinical practice guidelines. J Natl Compr Canc Netw 2007;5 Suppl 2:S1-S29. https://doi.org/10.6004/jnccn.2007.0001
  29. Hohenberger P, Ronellenfitsch U, Oladeji O, Pink D, Strobel P, Wardelmann E, et al. Pattern of recurrence in patients with ruptured primary gastrointestinal stromal tumour. Br J Surg 2010;97:1854-1859. https://doi.org/10.1002/bjs.7222

피인용 문헌

  1. Résection endoscopique des tumeurs sous-muqueuses gastriques de petite taille vol.46, pp.6, 2015, https://doi.org/10.1007/s10190-016-0571-4
  2. Robotic Gastrotomy With Intracorporeal Suture for Patients With Gastric Gastrointestinal Stromal Tumors Located at Cardia and Subcardiac Region vol.28, pp.1, 2015, https://doi.org/10.1097/sle.0000000000000498
  3. Robotic Wedge Resection for Unfavorably Located Gastric Gastrointestinal Stromal Tumors: Perioperative and Long-Term Oncological Outcomes vol.31, pp.7, 2021, https://doi.org/10.1089/lap.2020.0660