• Journal of Gastric Cancer
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• 제10권4호
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• pp.188-195
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• 2010

Purpose: This study was done to evaluate the usefulness of preoperative computed tomography (CT) and intraoperative laparoscopic ultrasound to facilitate treatment of gastric submucosal tumors. Materials and Methods: The feasibility of laparoscopic wedge resection as determined by CT findings of tumor size, location, and growth pattern was correlated with surgical findings in 89 consecutive operations. The role of laparoscopic ultrasound for tumor localization was analyzed. Results: Twenty-three patients were considered unsuitable for laparoscopic wedge resection because of large tumor size (N=13) or involvement of the gastroesophageal junction (N=9) or pyloric channel (N=1). Laparoscopic wedge resection was not attempted in 11 of these patients because of large tumor size. Laparoscopic wedge resection was successfully performed in 65 of 66 (98.5%) patients considered suitable for this procedure. Incorrect interpretation of preoperative CT resulted in a change of surgery type in seven patients (7.9%): incorrect CT diagnosis on gastroesophageal junction involvement (N=6) and on growth pattern (N=1). In 18 patients without an exophytic growth pattern, laparoscopic ultrasound was necessary and successfully localized all lesions. Conclusions: Preoperative CT and laparoscopic ultrasound are useful for surgical planning and tumor localization in laparoscopic wedge resection.

• Journal of Gastric Cancer
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• 제11권2호
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• pp.131-134
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• 2011

A laparoscopic wedge resection for a submucosal tumor, which is close to the gastroesophageal junction, is technically challenging. This can be a dilemma to both patients and surgeons when the tumor margin involves the gastroesophageal junction because a wedge resection in this situation might result in a deformity of the gastroesophageal junction or an injury to the lower esophageal sphincter, which ultimately results in lifelong gastroesophageal reflux disease. The patient was a 42 year-old male, whose preoperative endoscopic ultrasonographic finding did not rule out a gastrointestinal stromal tumor. He underwent a laparoscopic gastric wedge resection and prophylactic anterior partial fundoplication (Dor) and was discharged from hospital on the fifth postoperative day without any complications. There were no symptoms of reflux 5 months after surgery. A laparoscopic wedge resection and prophylactic anti-reflux surgery might be a good surgical option for a submucosal tumor at the gastroesophageal junction.

• Journal of Gastric Cancer
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• 제12권3호
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• pp.173-178
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• 2012

Purpose: To report the initial clinical experience with single-incision laparoscopic gastric wedge resection for submucosal tumors. Materials and Methods: The medical records of 10 patients who underwent single-incision laparoscopic gastric wedge resection between July 2009 and March 2011 were reviewed retrospectively. The demographic data, clinicopathologic and surgical outcomes were assessed. Results: The mean tumor size was 2.5 cm (range, 1.2~5.0 cm), and the tumors were mostly located on the anterior wall (4/10) or along the greater curvature (4/10), of the stomach. Nine of ten procedures were performed successfully, without the use of additional trocars, or conversion to laparotomy. One patient underwent conversion to multiport laparoscopic surgery, to get simultaneous cholecystectomy safely. The mean operating time was 66.5 minutes (range, 24~132 minutes), and the mean postoperative hospital stay was 5 days (range, 4~7 days). No serious perioperative complications were observed. Of the 10 submucosal tumors, the final pathologic report revealed 5 gastrointestinal stromal tumors, 4 schwannomas, and 1 heterotopic pancreas. Conclusions: Single-incision laparoscopic gastric wedge resection for gastric submucosal tumors is feasible and safe, when performed by experienced laparoscopic surgeons. This technique provides favorable cosmetic results, and also short hospital stay and low morbidity, in carefully selected candidates.

• Journal of Gastric Cancer
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• 제11권4호
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• pp.225-229
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• 2011

Purpose: Laparoscopic wedge resection of gastric submucosal tumor may be difficult in case of the endophytic mass or the mass located unreachable area such as cardia, and intragastric approach can be useful. We would present the experiences of the intragastric wedge resection. Materials and Methods: There were 7 patients diagnosed as gastric submucosal tumor and underwent the intragastric wedge resection at Surgery, Chungnam National University Hospital. We reviewed medical record. Results: There were 3 male and 4 female. Mean age was 65 years-old (57~73). Mean body mass index was 26.28 kg/$m^2$ (21.28~35.30). Location of lesions was 4 cardia, 2 fundus and 1 midbody, respectively. Mean operation time was 83.6 minutes (70~105). All patients were healed without any complication. Mean postoperative hospital stay was 5.4 days (4~6). Mean size was 2.7 cm (2.3~3.8). Pathologic finding was 5 gastrointestinal stromal tumor and 2 leiomyoma. Conclusions: The single incision intragastric wedge resection of gastric submucosal tumor is feasible and acceptable, especially in mass of gastric upper part.

• Journal of Gastric Cancer
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• 제21권2호
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• pp.111-121
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• 2021

Laparoscopic endoscopic cooperative surgery (LECS) refers to the endoscopic dissection of the mucosal or submucosal layers with laparoscopic seromuscular resection. We recommend a treatment algorithm for the LECS procedure for gastric benign tumors according to the protruding type. In the exophytic type, endoscopic-assisted wedge resection can be performed. In the endophytic type, endoscopic-assisted wedge resection of the anterior wall is relatively easy to perform, and endoscopic-assisted transgastric resection, laparoscopic-assisted intragastric surgery, or single-incision intragastric resection in the posterior wall and esophagogastric junction (EG Jx) can be attempted. We propose an algorithm for the LECS procedure for early gastric cancer according to the tumor location. The endoscopic submucosal dissection (ESD) procedure can be adapted for all areas of the stomach, and single-incision ESD can be performed in the mid to high body and the EG Jx. In full-thickness gastric resection, laparoscopy-assisted endoscopic full-thickness resection can be adapted for the entire area of the stomach, but it cannot be applied to the pyloric and EG Jx. In conclusion, surgeons need to select the LECS procedure according to tumor type, tumor location, the surgeon's individual experience, and the situation of the institution while also considering the advantages and disadvantages of each procedure.

• Journal of Gastric Cancer
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• 제6권4호
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• pp.207-213
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• 2006

목적 : 위에 발생한 위장관간질종양의 수술적 절제에 있어서, 최근 개발된 3차원 재구성 기술을 이용한 computed tomography (CT) gastrography의 유용성을 알아보고자 본 연구를 시행하였다. 대상 및 방법: 2001년 1월부터 2006년 2월까지 서울대학교병원 외과에서 위장관간질종양으로 수술을 시행받은 환자 중 CT gastrography를 시행하였던 38예를 대상으로 CT상 종양의 크기, 위치, 위식도 접합부위 또는 유문부부터 종양까지의 거리등을 조사하여 내시경, 수술 및 병리학적 소견과 비교하였다. 결과: CT gastrography 및 내시경 소견에서 종양의 종축상 위치는 수술 소견과 전 예에서 일치했으나 횡축상 위치는 CT gastrography 소견의 81.6% (31/38), 내시경 소견의 75.8% (25/33)만이 수술 소견과 일치하였다. 38예증 12예에서 복강경 설상절제술을 시행하였으며 26예에서 개복수술을 시행하였는데, CT gastrography 소견에서 종양의 크기가 5 cm 미만인 경우 42.3% (11/26)에서 복강경 설상절제술이 시행되었고, 5 cm 이상인 경우 8.3%(1/12)에서 복강경 설상절제술을 시행하였다. 종축 위치상 중부 1/3에 위치한 9예 중 8예(88.9%)에서 복강경 설상절제술이 시행된 반면, 상부 1/3이나 하부 1/3에 위치한 경우에는 29예 중 4예(13.8%)에서만 복강경 설상절제술이 시행되었다. 결론: 본 연구 결과 CT gastrography는 수술자에게 정확한 3차원적 정보를 제공함으로써 수술적 치료 방침 결정에 도움을 줄 수 있었다.

• Journal of Gastric Cancer
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• 제15권4호
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• pp.231-237
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• 2015

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.

• Journal of Gastric Cancer
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• 제24권1호
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• pp.122-134
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• 2024

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.

• Journal of Chest Surgery
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• 제46권4호
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• pp.293-294
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• 2013

Gastropleural fistula (GPF) is a rare condition that can occur as a consequence of prior pulmonary surgery, trauma, or malignancy. Conservative management usually fails, and gastrectomy and even thoracotomy is often required, especially in debilitated patients. We present a patient with GPF who had a history of Ewing's sarcoma. Diagnosis of GPF was confirmed by upper gastrointestinal system endoscopy and radiographic contrast examination, and the patient underwent a laparoscopic wedge resection of the fistula. To our knowledge, this is the first report of a GPF, in the formation of which recurrence of Ewing's sarcoma had played a role and in the treatment of which wedge resection of the fistula was performed. Laparoscopic treatment of GPF may be associated with less morbidity and should be considered as the initial procedure of choice.

• Journal of Gastric Cancer
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• 제4권3호
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• pp.196-203
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• 2004

The Information Committee of the Korean Gastric Cancer Association sent questionnaires to 31 laparoscopic gastric surgeons about their personal experiences with laparoscopic gastric surgery from 2001 to 2003. Twenty-four surgeons responded to the questionnaires (response rate: $77.4\%$).The number of laparoscopic gastric surgeries from 2001 to 2003 was 1,130 and increased from 209 in 2001 to 593 in 2003. The number of operations for a gastric adenocarcinoma also increased from 87 cases in 2001 to 403 cases in 2003. Laparoscopic radical procedures, such as a laparoscopyassisted distal gastrectomy or total gastrectomy (LADG or LATG), have increased rapidly during this period. (55 cases in 2001, 150 cases in 2002, and 364 cases in 2003). Laparoscopic function-preserving gastrectomies were not performed until 2003, during which year one pylorus- preserving gastrectomy and six proximal gastrectomies were performed laparoscopically. A wedge resection for a gastric submucosal tumor was performed in 71 cases in 2001, 82 in 2002, and 103 in 2003. Hand-assisted laparoscopic surgery (HALS) was performed in 39 cases in 2001, 55 in 2002, and 49 in 2003. As for personal indications for a LADG, 14 surgeons performed a LADG only for a T1 lesion, and 5 surgeons extended their indications to T2N0 lesions. In the near future, laparoscopic procedures for gastric cancer will be widely adopted in Korea if the medical-insurance obstacle is overcome and the long-term survival results are verified.