Laparoscopic management of gastric gastrointestinal stromal tumors

Table 1 Non-comparative series of laparoscopic resection of gastric gastrointestinal stromal tumor

Ref.	n	Age (yr)	Tumor size	Tumor localization	Type of surgery	OR time (min)	Notes	Complications/ conversions	Follow-up (mo)
Privette et al[25]	12	60.5	5.2 cm PG 4.6 cm TransG 5.5 cm DG	5 Fundus or greater curvature 3 Prepyloric or antral 5 Lesser curvature	5 PG × Lap 3 DG × Lap 5 TransG × Lap	PG 180 (122-262) DG: 322 (256-340) TransG: 236 (202-265)	9/12 GIST 1 Schwannoma 2 Leiomiomas LOS: GP: 3.4 GD: 8.3 GT: 3.3	16.6% complication 1 Enterotomy 1 GI Bleeding No conversions	Only specified for 5 pts
Sexton et al[32]	61	59.1 ± 19	3.8 ± 1.8 AR: 229.7 NAR 140.9	Fundus 19 Antrum 18 Body 17 GE junction 7 Pylorus 2	PG 52 DG 4 TotGas 3 TransG 3	151.9 ± 67.3	LOS: 3.9 ±2 LOS AR: 3.9, NAR: 4.1	16.4% complication No conversions 1 POP death	15 (0-103) 3 recurrences
Berindoague et al[9]	22	66.7	5.6 (2.5-12.5)	Upper third 6 Middle third 7 Lower third 10	GP 13 1 LAP-HA TotGas 1 LAP TotGast 1 LAP-HA GD 1 TransG	NR	18/22 GIST 1 Adenomyoma 1 Hamartoma 1 Plasmocytoma 1 Parasitic Tumor (anisakis) LOS 6 (4-32)	18.2% complication 3 Delayed gastric emptying 1 Intestinal Obstruction 2 Conversions (9.1%)	32 m (1-72) 1 recurrence
De Vogelaere et al[24]	31	63.8	4.4 (0.4-11)	Anterior gastric wall 23 Others not specified	31 PG	99	LOS 8.5	3.2% Complication 1 POP Bleeding	56.3 No recurrences
Hwang et al[10]	63	52.8	3.5 GE Junction 3.4 Prepyloric Size of other tumor not specified	7 GE junction Upper third 22 Middle third 11 Lower third 19 4 Prepyloric	3 DG 37 PG 23 TransG (5 Enucleations)	86.1 ± 43.7	LOS 5.3 ± 1 1.8 41 GIST 8 Leiomyoma 4 Carcinoids 1 Liposarcoma 6 Heterotopic Pancreas 2 Hyperplastic Polyps 1 Parasitic Infection	4.7% Complication 1 Staple line bleeding 1 SSI 1 Staple line dehiscence	14.9 (2-42) No recurrences
Novitsky et al[26]	50	60 ± 13	4.4 ± 2.0 cm	GE Junction 8 Cardias 9 Anterior Wall 10 Posterior Wall 4 Greater Curvature 6 Lesser Curvature 3 Antrum 4 Prepyloric 6	TotGas 1 DG 2 PG 40 LAP/END 4 LAP-HA 3	135 ± 56	LOS 3.8 ± 1.6	8% 4 Minor complications	36 (4-84) 4 recurrences
Lai et al[2]	28	56.9 ± 12.4	3.4 ± 1.6	Upper third 13 Middle third 8 Lower third 7	28 PG	189.6 ± 79.5 Stapled 194.3 ± 50.5 Hand-Sewn	LOS 6.7 ± 1.8	3.5% conversion	43.3 ± 23.5 No recurrences
Choi et al[36]	23	59.7 ± 8.3	4.2 ±2.1	Upper third 13 Middle third 5 Lower third 5	23 PG	104.3	LOS 5.2 ± 2.3	4.3% complication 1 Delayed gastric emptying No conversions	61 (7-98)
Nguyen et al[22]	28	65	4.6 (0.4-11.5)	LAP PG 22 Subtotal Gastrectomy 3 OS (Converted) : TotGas 1 Intraluminal excision 1 1 Not specified	23 GP × LAP 3 GD × LAP 1 GT × LAP 1 TotGas × CA (converted)	143 (46-336) This includes Small Bowel GIST resections. No data only on gastric resections	LOS 4 (1-50 d)	9% complications 11% 3 conversions Mortality 1 POP death This includes Small Bowel GIST resections. No data only on gastric resections	NS
Huguet et al[37]	33	68	3.9 (0.5-10.5),	GE Junction 5 Body 24 Antrum 4	PG 29 LAP-HA PG 4	124 (30-253)	LOS 3 (1-40)	9% complications 2 POP Bleeding 1 SSI 6% conversions	13 (3-64) No recurrences
Ronellenfitsch et al[38]	17	56 (43-79)	2.9 (0.8-6)	11 Not specified 6 Antrum	17 PG	130 (80-201)	LOS 7 (5-95)	11.8% Complications: Staple leaks 5% conversion (peritoneal adhesions)	18 (1-53) No recurrences
Tagaya et al[39]	15	65.3 (52-75 years)	TransG 2.9 (1.7-6.5) GP 3.9 (1.2-8)	TransG: Upper third 4 Middle third 1 Lower third 1 PG: Greater curvature 2 Lesser curvature 1 Anterior wall 2 Middle third Ant wall 1 Middle Third Post wall 1	TransG 8 PG 7	TransG:168 (132-211) PG: 121 (60-190)	LOS TransG: 8.8 ( 7-12) LOS PG: 9.6 (7-14)	No complications	After final Pathology only 9 tumors were GIST TransG 18-73 PG: 6-122 No recurrences

GLA: Gasless laparoscopy-assisted; PG: Wedge Resection or Partial Gastrectomy; DG: Distal Gastrectomy; TransG: Transgastric Gastrectomies; TotGas: Total Gastrectomy; OS: Open surgery; AR: Anatomic resections; NAR: Non-anatomic resections; LOS: Length of stay; NS: Not specified; LAP/END: Laparoendoscopic resection; LAP-HA: Laparoscopic hand-assisted; RG: Remnant Gastrectomy; Prox Gas: Proximal Gastrectomy; SSI: Surgical site infection.

Table 2 Comparative series of laparoscopic resection of gastric gastrointestinal stromal tumor

Ref.	n	Age	Tumor size	Tumor localization	Type of surgery	OR time (min)	Notes	Complications/ conversions	Follow-up (mo)
Wu et al[8]	28	61.6 GLA 60.7 CA	2.6 ± 1 1.8 GLA 2.5 ± 1.0 CA	Anterior fundus: 5 GLA 5 CA Posterior fundus: 6 GLA 2 CA Anterior body: 3 GLA 3 CA Posterior Body: 1 GLA 3 CA	15 GLA 13 OS All were Wedge Resections	GLA 129 ± 36.1 CA 110.8 ± 38.1	GLA Less POP Pain during the first 3 d Earlier oral intake Less LOS 5.8 vs 7.2 días	7.1% complication 1 OS Ileus 1 Enterotomy during GLA corrected during LAP	NR
Catena et al[7]	21	50.1	4.5 ± 2.0	Body 16 Antrum 4 Fundus 1	21 PG	151 ± 56	LOS 4.8 ± 1.6	No intraoperative complications	35 (5-58)
	25	54.6	6.2 ± 1.9	Body 17 Antrum 6 Fundus 2	25 OS (PG)	134 ± 33	LOS 7.1 ± 1.2	No differences in complications	91 (80-136) 1 recurrence
Melstrom et al[31]	46	62 Lap	OS 6.39 82.1-10)	Lap: Upper third 6 Middle third 10 NS 1 OS: Upper third 6 Lower third 22 NS 1	17 PG 24 PG × OS 4 DG × OS 1 TotGas × OS	Lap 135 OS 157	LOS: OS 6.25 LAP 2.68 I	Complications OS: 13.8% LAP: 11.8% 6% conversion	OS 59 4 recurrences LAP 32 No Recurrences
	17 LAP	60 OS	LAP 4.27 (1.5-9.1)
	29 OS
De Vogelaere et al[11]	53		Total 5.9					LAP : 2.7% 1 Pulmonary	Lap 83
	37 LAP	LAP 63.7 ± 15.4	LAP 5.6	Not specified	Not specified	LAP 48.5 ± 16	LOS Lap 7	Embolism	No Recurrences LAP
	16 OS	OS 63.7 ± 10.7	OS 7.5	Not specified	Not specified	OS 155 ± 48.1	LOS OS 14	OS 18.7% complications: Pneumonia 1 Anastomotic Ulcer 1 Fistula 1	OS 71 6 recurrences CA
Karakousis et al[40]	80	68	OS 4.3 (2-9)	OS : Fundus 7	OS 39 PG 1 DG	OS 89 LAP 96	LOS: LAP 4 OS 7	Complications OS 25% LAP 14% 32.5% Conversions	LAP 28 (0.3-70 m) Recurrences 1 LAP OS 43 (0.1-139) Recurrences 1 OS
	OS 40		LAP 3.6 (0-7-7.8)	Body/antrum 32 Pylorus 1 Lesser curvature 12	LAP 40 PG
	LAP 40			LAP: Fundus 3 Body/antrum 37 Pylorus 0 Lesser curvature 10
Kim et al[41]	104 LAP 80 OS 24	59.8 ± 10.5	5.1 ± 3.3	Upper third 61 Middle third 24 Lower third 19	Technique according to procedures was NS 99 PG 5 TotGas	LAP 91.1 ± 57 CA 165.8 ± 75.6	LOS LAP 4.6 ± 2.3 CA 9.8 ± 4.1	1% Complications 1 Delayed Gastric Emptying	49.3 (8.4-164.4) Recurrences 5 No Difference in recurrences between OS and LAP
Silberhummer et al[21]	63 OS 41 LAP 22	62.3 ± 14.4	CA 5.8 ± 4.0 LAP 3.5 ±1.4	Body 29 Antrum 18 Fundus 10 GE Junction 6	OS: PG 32 DG 5 RG 4 LAP 19 Tumorectomy 3 PG	135 ± 56	LOS LAP 7.8 (± 3.1) LOS CA 12.8 ± 5.0	4.7% complications: 1 Gastrocutaneous Fistula 1 Catheter Sepsis 1 POP Ileus LAP: 18.2% conversions	37 ± 27.9 Recurrences in 4 (7%)
Nishimura et al[42]	LAP 39	62	LAP 3.8 (0.8-7.3)	LAP: Upper third 19 Middle third 16 Lower third 4	LAP GP: 12 LAP-HA 17 TransG 10	LAP: 136 min OS: 115 min	NR	No Complications Conversion Rate 2.6%	LAP: 18.9 (2.6-96.4) Recurrences 4 LAP
	OS 28		OS: 4.2 (2.0-7.0)	OS Upper third 11 Middle third 11 Lower third 6	OS PG: 19 Prox Gas: 5 TotGas: 3 DG:1				OS: 31.2 (4.4-121.9) 1 Recurrence OS
Otani et al[43]	60 OS 22 LAP 38	59 (32-86)	4,25 (1.8-15.0)	Upper third 36 Middle third 20 Lower third 4	LAP: PG: 35 LAP-HA: LAP-HA PG 2 LAP-HA DG 1 OS: PG 11 ProxGas 9 DG 2	LAP 141 LAP-HA 188 CA 197	LOS LAP 7.2 vs 13.7 CA	3.3% complications: 1 Gastric Stenosis 1 Anastomotic Leak	53 mo 2 Recurrences

GLA: Gasless laparoscopy-assisted; PG: Wedge resection or partial gastrectomy; DG: Distal gastrectomy; TransG: Transgastric gastrectomies; TotGas: Total gastrectomy; OS: Open surgery; AR: Anatomic resections; NAR: Non-anatomic resections; LOS: Length of stay; NS: Not specified; LAP/END: Laparoendoscopic resection; LAP-HA: Laparoscopic hand-assisted; RG: Remnant gastrectomy; Prox Gas: Proximal gastrectomy; SSI: Surgical site infection.