Système gastro-intestinal et digestif

Abstrait

Minimally Invasive Resection of Gastric Gists: A Laparo-endoscopic Solution

Marano Luigi, Porfidia Raffaele, Reda Gianmarco, Grassia Michele, Petrillo Marianna, Esposito Giuseppe, Braccio Bartolomeo, Pezzella Modestino, Gallo Pierluigi, Romano Angela and Di Martino Natale

Although the feasibility of minimally invasive resections of gastric gastrointestinal stromal tumors (GISTs) has been established, many aspects of this approach are still debated: in different scientific papers, gastroscopy during laparoscopy seems to be an effective technique for successful intraoperative tumor identification. 9 patients were referred to our institution for gastric GISTs. Preoperative work-up for all patients included medical history, standard blood tests, upper gastrointestinal endoscopy with endoscopic ultrasound examination and computed tomography scan. One of these patients underwent open surgery for acutely presentation (haemorrhage), and the other 8 underwent laparoscopic-endoscopic “rendez-vous” resection. The average operative time was 134.1 ± 59.3 min. The mean estimated blood loss was less than 62 ml (range, 10-174 ml). There were no episodes of tumor rupture or spillage, no major intraoperative complications and a conversion rate of 25%. At a mean follow-up of 25 months (range, 3-41) all patients are alive and disease free. There were no local recurrences. Given these findings, a minimally invasive approach should be the preferred surgical treatment in patients with small and medium-sized gastric GIST; moreover a selective approach to laparoscopic resection based on tumor location allows safe resection of these tumors with low morbidity and no compromise of oncologic principles.