Laparoscopic transgastric resection of gastric submucosal tumor located near the esophagogastric junction

Abstract

Background: Laparoscopic wedge resection is widely accepted as a choice of treatment for gastric submucosal tumors (SMTs). But it cannot easily be applied to tumors located near the esophagogastric junction (EGJ) due to the high risk of causing deformity or stenosis in the gastric inlet. We evaluated our laparoscopic transgastric surgical technique for gastric SMTs located near the EGJ and clinical outcomes. Methods: Twelve consecutive patients with gastric intraluminal SMTs located 3 cm or less from the EGJ underwent laparoscopic transgastric resection at our institution from June 2010 to November 2012. The clinicopathological results of these 12 cases were analyzed. Results: Laparoscopic transgastric resection was successfully performed on all the patients. The mean operation time was 125 +/- 25 min (range, 85-160 min) and the mean blood loss was 53 +/- 32 mL (range, 10-120 mL). There was no death in our series. One patient experienced a postoperative complication of upper gastrointestinal tract bleeding due to the errhysis along the staple line treated with an endoscopic hemostatic clip. The mean postoperative length of hospital stay was 5.1 +/- 1.2 days (range, 3-7 days). All patients received complete resection with a negative margin. Histopathologic diagnoses were gastrointestinal stromal tumor in seven cases, leiomyoma in four, and heterotopic pancreas in one. There was no tumor recurrence or evidence of stenosis of the EGJ during a mean follow-up of 15.3 +/- 9.6 months (range, 1-30 months). Conclusions: Laparoscopic transgastric resection is simple, safe, and effective for gastric intraluminal SMTs located near the EGJ. © 2013 The Society for Surgery of the Alimentary Tract.