Laparoscopic Local Resection through Subserosal Dissection with Endoscopic Air-Insufflation for Submucosal Tumors Located Near the Esophagogastric Junction

Purpose A novel resection method, namely, laparoscopic local resection through subserosal dissection with endoscopic air-insuff lation (LRSDEA) was used for submucosal tumors located near the esophagogastric junction (SMT-EGJ) to avoid major gastric resection. Methods A total of 9 cases underwent LRSDEA. We sequentially performed: laparoscopic dissections around EGJ, subserosal dissections around SMTs using laparoscopic electrocautery and ultrasonic shears, and finally, enucleation of SMTs. During these procedures, intraoperative endoscopic tumor localization, as well as endoscopic air-insufflation allowed for safe resection. These procedures are shown in the supplementary video clip. The clinicopathological characteristics and surgical results were analyzed. Results All laparoscopic procedures were successfully performed without requiring a major gastrectomy. The mean operation time was 126.1 minutes, and estimated blood loss was 12.0 ml. There were no postoperative complications. Pathological diagnoses were 6 leiomyomas, 2 gastrointestinal stromal tumors, and 1 gastric duplication. Conclusion LRSDEA is an effective and safe treatment option for SMT-EGJ, as major resection of the stomach is avoided.

[1]  O. Kwon,et al.  Endoscopic and Laparoscopic Full-Thickness Resection of Endophytic Gastric Submucosal Tumors Very Close to the Esophagogastric Junction , 2015, Journal of gastric cancer.

[2]  D. Park,et al.  Single-incision intragastric resection for upper and mid gastric submucosal tumors: a case-series study , 2014, Annals of surgical treatment and research.

[3]  K. Caca,et al.  Endoscopic full-thickness resection of gastric subepithelial tumors: a single-center series , 2014, Endoscopy.

[4]  H. Udagawa,et al.  Feasibility and safety of laparoscopic and endoscopic cooperative surgery for gastric submucosal tumors, including esophagogastric junction tumors , 2014, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society.

[5]  Xiao-wu Xu,et al.  Laparoscopic Transgastric Resection of Gastric Submucosal Tumors Located Near the Esophagogastric Junction , 2013, Journal of Gastrointestinal Surgery.

[6]  Yoon-Koo Kang,et al.  Clinical Practice Guideline for Accurate Diagnosis and Effective Treatment of Gastrointestinal Stromal Tumor in Korea , 2012, Cancer research and treatment : official journal of Korean Cancer Association.

[7]  C. Antonescu,et al.  NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumors. , 2010, Journal of the National Comprehensive Cancer Network : JNCCN.

[8]  Y. B. Choi,et al.  Laparoscopy in the management of gastric submucosal tumors , 2000, Surgical Endoscopy.

[9]  K. Lee,et al.  Laparoscopic surgery for submucosal tumors located at the esophagogastric junction and the prepylorus , 2009, Surgical Endoscopy.

[10]  S. Hirota,et al.  Clinical practice guidelines for gastrointestinal stromal tumor (GIST) in Japan: English version , 2008, International Journal of Clinical Oncology.

[11]  Y. Seto,et al.  Laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor dissection , 2008, Surgical Endoscopy.

[12]  K. Song,et al.  Tailored-approach of laparoscopic wedge resection for treatment of submucosal tumor near the esophagogastric junction , 2007, Surgical Endoscopy.

[13]  Seung Ho Choi,et al.  Laparoscopic resection of a huge intraluminal gastric submucosal tumor located in the anterior wall: Eversion method , 2005, Journal of surgical oncology.

[14]  H. Jung,et al.  Intraoperative gastroscopy for gastric surgery , 2005, Surgical Endoscopy And Other Interventional Techniques.

[15]  L. Sobin,et al.  Diagnosis of gastrointestinal stromal tumors: A consensus approach. , 2002, Human pathology.

[16]  B. Heniford,et al.  Laparoscopic vs open resection of gastric stromal tumors , 2002, Surgical Endoscopy and Other Interventional Techniques.

[17]  N. Tagaya,et al.  Laparoscopic intragastric stapled resection of gastric submucosal tumors located near the esophagogastric junction , 2001, Surgical Endoscopy And Other Interventional Techniques.