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Kansoun A, Omouri A, Hamed S. Minimally invasive resection of gastric GIST tumor by trans-gastric approach: A case report of a novel technique. Int J Surg Case Rep 2024; 122:110178. [PMID: 39153340 PMCID: PMC11378970 DOI: 10.1016/j.ijscr.2024.110178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 08/10/2024] [Accepted: 08/14/2024] [Indexed: 08/19/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE GIST (Gastro Intestinal Stromal Tumor) treatment is surgical however surgical resection, especially for gGIST (gastric GIST), may be challenging due to location of tumor and the possible sequelae post resection. CASE PRESENTATION We present a case of 66-year-old female presented for the management of gGIST. We opted for transgastric resection assisted by robot. The resection was with free surgical margins for a 4 cm GIST tumor low in grade. CLINICAL DISCUSSION Classical wedge resection of gastric tumors poses post-operative complications especially if the tumor is located near the cardia or pylorus. Various minimally invasive techniques were described aiming to avoid post-operative complications as in stenosis and gastric reflux. CONCLUSION Minimally invasive transgastric resection of gGIST tumor seems to be worth of attention for it can prevent stenosis, hemorrhage and can preserve gastric tissue. Further studies need to be involved to endorse this technique.
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Affiliation(s)
- Alaa Kansoun
- Department of Visceral and Endocrine Surgery, Saint Joseph Hospital, Marseille 13008, France.
| | - Adel Omouri
- Department of Viscerale Surgery, Aix-Marseille University, Faculty of Medical Sciences, Marseille, France
| | - Sami Hamed
- Department of Visceral and Endocrine Surgery, Saint Joseph Hospital, Marseille 13008, France
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Yasuda A, Kimura Y, Kato H, Nakanishi T, Koda M, Hiraki Y, Hagi T, Shiraishi O, Shinkai M, Imano M, Yasuda T. Surgical tips and tricks for laparoscopic intragastric surgery for submucosal tumors relative to the esophagogastric junction. Updates Surg 2024; 76:1389-1396. [PMID: 38216795 DOI: 10.1007/s13304-023-01740-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 12/19/2023] [Indexed: 01/14/2024]
Abstract
Recent reports have described the practicality of laparoscopic intragastric surgery (l-IGS) as an alternative for resecting submucosal tumors (SMTs) near the esophagogastric junction (EGJ), where excision using an exogastric approach would be difficult. However, even using IGS to perform a full-thickness resection of SMTs that are in or extremely close to the EGJ is very difficult to do safely and avoid disrupting or causing stenosis of the EGJ, without advanced experience. This study retrospectively examined the usefulness of l-IGS for gastric SMTs located in or extremely close to the EGJ. Fourteen patients with gastric SMTs < 2 cm of the EGJ and underwent l-IGS were eligible for this study. We examined the tumor location, operative time, intraoperative hemorrhage, degree of deformation, gastroesophageal reflux disease, perioperative complications, and recurrence. Furthermore, we compared patients with tumors in the EGJ with those with tumors near the EGJ and patients in whom three-port l-IGS was performed with those who underwent single-incision laparoscopic surgery. The average tumor size, operative time, intraoperative hemorrhage, and postoperative hospitalization of the 14 patients were 30.9 ± 21.3 mm, 125.2 ± 31.1 min, 30.7 ± 103.3 mL, and 9.2 ± 3.1 d, respectively. No differences in these parameters according to the type of l-IGS or tumor location were observed. All patients underwent l-IGS without complications and were free from EGJ deformation or esophagitis. We believe that l-IGS is useful for gastric SMTs located < 2 cm of the EGJ as it can be safely performed for difficult tumor locations and does not cause deformation of the EGJ.
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Affiliation(s)
- Atsushi Yasuda
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
| | - Yutaka Kimura
- Department of Surgery, Kindai Nara Hospital, 1248-1 Otoda-Tyo, Ikoma, Nara, 650-0293, Japan
| | - Hiroaki Kato
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Tomoya Nakanishi
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Masashi Koda
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Yoko Hiraki
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Takaomi Hagi
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Osamu Shiraishi
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Masayuki Shinkai
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Motohiro Imano
- Cancer Center, Kindai University Hospital, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Takushi Yasuda
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
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Ishizuka C, Ishikawa T, Yagi H, Yamamoto Y, Koro D, Nishikoshi T, Koshizuka Y, Yanagida N, Shibaki T, Akabane H, Yasuda S, Ishibashi K, Taketomi A. Robot-assisted distal gastrectomy and local resection for gastric cancer and gastrointestinal stromal tumor. Asian J Endosc Surg 2024; 17:e13310. [PMID: 38623612 DOI: 10.1111/ases.13310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/17/2024]
Abstract
Gastrointestinal stromal tumors surrounding the esophagogastric junction are often challenging to resect, with no consensus regarding the optimal surgical technique. Here in, we present a case of concurrent gastric cancer in the antrum and gastrointestinal stromal tumors adjacent to the esophagogastric junction. The patient underwent simultaneous distal gastrectomy and local resection assisted by a surgical robot, avoiding the need for total gastrectomy. The utilization of robot-assisted surgery has become an increasingly popular technique, holding promise for simplifying complex surgical procedures across diverse medical settings.
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Affiliation(s)
- Chihiro Ishizuka
- Department of General Surgery, Asahikawa-Kosei General Hospital, Asahikawa, Japan
| | - Takahisa Ishikawa
- Department of General Surgery, Asahikawa-Kosei General Hospital, Asahikawa, Japan
| | - Hayato Yagi
- Department of General Surgery, Asahikawa-Kosei General Hospital, Asahikawa, Japan
| | - Yoichi Yamamoto
- Department of General Surgery, Asahikawa-Kosei General Hospital, Asahikawa, Japan
| | - Daisuke Koro
- Department of General Surgery, Asahikawa-Kosei General Hospital, Asahikawa, Japan
| | - Takahiro Nishikoshi
- Department of General Surgery, Asahikawa-Kosei General Hospital, Asahikawa, Japan
| | - Yasuyuki Koshizuka
- Department of General Surgery, Asahikawa-Kosei General Hospital, Asahikawa, Japan
| | - Naoyuki Yanagida
- Department of General Surgery, Asahikawa-Kosei General Hospital, Asahikawa, Japan
| | - Taiichiro Shibaki
- Department of General Surgery, Asahikawa-Kosei General Hospital, Asahikawa, Japan
| | - Hiromitsu Akabane
- Department of General Surgery, Asahikawa-Kosei General Hospital, Asahikawa, Japan
| | - Shunsuke Yasuda
- Department of General Surgery, Asahikawa-Kosei General Hospital, Asahikawa, Japan
- Department of Respiratory Surgery, Asahikawa-Kosei General Hospital, Asahikawa, Japan
| | - Kei Ishibashi
- Department of Respiratory Surgery, Asahikawa-Kosei General Hospital, Asahikawa, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery 1, Hokkaido University Graduate School, Sapporo, Japan
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Farrukh M, Braden B, Sgromo B. How-I-do-it: laparoscopic intragastric submucosal dissection (LISD) for gastric and gastro-oesophageal junction early lesions. Langenbecks Arch Surg 2024; 409:101. [PMID: 38506938 DOI: 10.1007/s00423-024-03289-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/15/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE Laparoscopic intragastric submucosal dissection (LISD) is a novel approach to the resection of gastric lesion that are not amenable to conventional endoscopic approaches. The technique permits favourable access to lesions situated at the cardia and angular notch of the stomach, enables en-bloc resection of large areas of tissue, and can prevent the need of formal gastrectomy or oesophagectomy in selected patients. METHODS All cases were deemed suitable for LISD by a multidisciplinary team panel following endoscopic assessment (using white light enhancement, chromoendoscopy and magnification endoscopy) that was integrated when needed with EUS, CT scan or PET scan. The surgical technique consisted in a 3-port laparoscopic approach; after establishment of pneumoperitoneum, three gastrotomies were performed to enable port insertion into the stomach. Following establishment of stable pneumogastrium, the area of interest was identified, submucosal hyaluronic acid injection performed to provide a cushion in the plane of dissection, and the excision area was circumferentially marked with cautery. Resection was completed using cautery hook, along a plane parallel to the muscolaris propria. After the specimen was extracted in a retrieval bag, intracorporeal single layer running suture closure of gastrotomies was performed. The abdominal wall closed by layers and tap block performed along with local anaesthetic injection on skin incision. Measures were taken to ensure correct orientation of resected specimens prior to fixation. RESULTS During the study period that spans from 2014 and 2022, a total of 11 patients underwent LISD for limited lesions of the stomach, 10 were located at gastro-oesophageal junction and one at the angular incisura. Four patients were female, seven males. The median age was 74 (46-79) years. R0 resection rate was 54.5%. Mean operative time was 109 min with very low blood loss (10 ml). Mortality rate was 0%, no immediate major complications (Grade II-V Clavien Dindo), including haemorrhage or perforation, occurred in these cases. Two patients developed dysphagia later that was successfully treated with endoscopic balloon dilatations. Median hospital stay was 3 days and median oral intake was on day 1 post-procedural. CONCLUSIONS Laparoscopic intragastric submucosal dissection is shown to be a safe and effective intervention for the treatment of early gastric cancers in selected patients having undergone deemed not amenable for endoscopic submucosal resection for their technically challenging location. Its application can serve as route to avoid formal surgery and the associated morbidity.
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Affiliation(s)
- Maira Farrukh
- Digestive Endoscopy Unit, G. Bernabeo Hospital, Ortona, Italy.
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK
| | - Bruno Sgromo
- Department of Upper GI Surgery, Churchill Hospital, Oxford, UK
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Symer MM, Zheng X, Pua BB, Sedrakyan A, Milsom JW. Contemporary Assessment of Adhesiolysis and Resection for Adhesive Small Bowel Obstruction in the State of New York. Surg Innov 2024:15533506241240580. [PMID: 38498843 DOI: 10.1177/15533506241240580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND Adhesive small bowel obstruction (aSBO) is a common surgical problem, with some advocating for a more aggressive operative approach to avoid recurrence. Contemporary outcomes in a real-world setting were examined. STUDY DESIGN A retrospective cohort study was performed using the New York Statewide Planning and Research Cooperative database to identify adults admitted with aSBO, 2016-2020. Patients were stratified by the presence of inflammatory bowel disease (IBD) and cancer history. Diagnoses usually requiring resection were excluded. Patients were categorized into four groups: non-operative, adhesiolysis, resection, and 'other' procedures. In-hospital mortality, major complications, and odds of undergoing resection were compared. RESULTS 58,976 patients were included. 50,000 (84.8%) underwent non-operative management. Adhesiolysis was the most common procedure performed (n = 4,990, 8.46%), followed by resection (n = 3,078, 5.22%). In-hospital mortality in the lysis and resection groups was 2.2% and 5.9% respectively. Non-IBD patients undergoing operation on the day of admission required intestinal resection 29.9% of the time. Adjusted odds of resection were highest for those with a prior aSBO episode (OR 1.29 95%CI 1.11-1.49), delay to operation ≥3 days (OR1.78 95%CI 1.58-1.99), and non-New York City (NYC) residents being treated at NYC hospitals (OR1.57 95%CI 1.19-2.07). CONCLUSION Adhesiolysis is currently the most common surgery for aSBO, however nearly one-third of patients will undergo a more extensive procedure, with an increased risk of mortality. Innovative therapies are needed to reduce the risk of resection.
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Affiliation(s)
- Matthew M Symer
- Department of Surgery, Division of Colon and Rectal Surgery, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Xinyan Zheng
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Bradley B Pua
- Department of Radiology, Division of Vascular and Interventional Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Art Sedrakyan
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Jeffrey W Milsom
- Department of Surgery, Division of Colon and Rectal Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
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Maeda A, Uchita K, Iwasaki T, Yamai H. Combination of endoscopic full-thickness resection and laparoscopic intragastric surgery for gastric submucosal tumor. Endoscopy 2023; 55:E1195-E1196. [PMID: 37963591 PMCID: PMC10645536 DOI: 10.1055/a-2191-2310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Affiliation(s)
- Atsuki Maeda
- Department of Gastroenterology, Kochi Red Cross Hospital, Kochi, Japan
| | - Kunihisa Uchita
- Department of Gastroenterology, Kochi Red Cross Hospital, Kochi, Japan
| | - Takehiro Iwasaki
- Department of Gastroenterology, Kochi Red Cross Hospital, Kochi, Japan
| | - Hiromichi Yamai
- Department of Surgery, Kochi Red Cross Hospital, Kochi, Japan
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Seo JW, Park KB, Chin HM, Jun KH. Is single incision laparoscopic surgery (SILS) for gastric gastrointestinal stromal tumor (GIST) dependent on the location of the tumor? BMC Surg 2023; 23:247. [PMID: 37605202 PMCID: PMC10441706 DOI: 10.1186/s12893-023-02141-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 08/05/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND We compared the surgical outcomes of single-incision laparoscopic surgery (SILS) and conventional laparoscopic surgery (CLS) for gastric gastrointestinal stromal tumor (GIST). METHODS We performed single-incision gastric wedge resection on prospectively-enrolled 15 consecutive patients with gastric GIST between November 2020 and April 2022 in a single tertiary center. The early perioperative outcomes of these patients were compared to those of patients who underwent CLS. The indications did not differ from those for conventional laparoscopic procedures for gastric GIST. RESULTS In total, 30 patients were assigned to the SILS (n = 15) and CLS (n = 15) groups. There were no significant differences in the estimated blood loss and intraoperative blood transfusion between the SILS and CLS groups. There were no intraoperative complications or conversions to multiple-port or open surgery in the SILS group. Proximally located tumors were more commonly treated with CLS than with SILS (P = 0.045). GISTs located in the greater curvature were more commonly treated with SILS than with CLS, although the difference was not statistically significant (P = 0.08). The mean incision length in the SILS group was 4.1 cm shorter than that in the CLS group (3.2 ± 0.7 and 7.3 ± 5.2 cm, respectively, P = 0.01). The postoperative analgesic dose was significantly lower in the SILS than in the CLS group (0.4 ± 1.4 and 2.1 ± 2.3, respectively P = 0.01). Also, the duration of postoperative use of analgesic was shorter in SILS than in CLS (0.4 ± 0.7 and 2.0 ± 1.8, respectively, P = 0.01). There were no significant differences in the early postoperative complications between the groups. CONCLUSIONS SILS is as safe, feasible, and effective for the treatment of gastric GIST as CLS with comparable postoperative complications, pain, and cosmesis. Moreover, SILS can be considered without being affected by the type or location of the tumor.
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Affiliation(s)
- Ji Won Seo
- Department of Surgery, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki Bum Park
- Department of Surgery, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyung Min Chin
- Department of Surgery, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyong-Hwa Jun
- Department of Surgery, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
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Stiekema J, Luttikhold J, Heineman D, Neerincx M, Daams F. Minimally invasive technique for gastric GIST at challenging locations: single incision surgical gastroscopy. Updates Surg 2023; 75:953-958. [PMID: 37004654 PMCID: PMC10284978 DOI: 10.1007/s13304-023-01484-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/23/2023] [Indexed: 04/04/2023]
Abstract
Organ sparing resection of gastrointestinal stromal tumors (GISTs) located in the proximal stomach or esophagogastric junction can be challenging, resulting in proximal or total gastrectomy to facilitate a radical resection without tumor spill. We developed and evaluated a single incision surgical gastroscopy (SISG) procedure to provide a technically feasible alternative for the removal of gastric GISTs at these challenging locations. We developed an endoluminal resection of gastric GISTs through a small single abdominal incision and longitudinal ventral gastrotomy. Patients with a proximal tumor location, in whom a wedge resection was deemed challenging on pre-operative investigation were included in the current series. Safety, short-term oncological and surgical outcome were evaluated. We performed SISG in six consecutive patients with histopathological proven or suspected gastric GIST. In all patients, the procedure was performed successfully with no tumor rupture. The mean operative time was 61 min and there were no significant complications. Pathological examination showed a microscopically radical resection in all patients. Single incision surgical gastroscopy is a feasible technique with excellent short-term oncological and surgical outcomes. This technique serves as a good alternative for complicated resections for gastric GISTs at challenging locations.
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Affiliation(s)
- Jurrien Stiekema
- Department of Surgery, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Joanna Luttikhold
- Department of Surgery, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - David Heineman
- Department of Surgery, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Maarten Neerincx
- Department of Gastroenterology and Hepatology, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands.
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Yasuda A, Kimura Y, Shiraishi O, Shinkai M, Imano M, Yasuda T. A case of a gastric gastrointestinal stromal tumor in the esophagogastric junction successfully treated by laparoscopic intragastric resection. Int J Surg Case Rep 2023; 106:108156. [PMID: 37054541 PMCID: PMC10123243 DOI: 10.1016/j.ijscr.2023.108156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/15/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Laparoscopic wedge resection has been widely performed for gastric gastrointestinal stromal tumors (GISTs). However, because GISTs in the esophagogastric junction (EGJ) are prone to deformity and postoperative functional disorders, laparoscopic resection is technically very difficult and rarely reported. Herein, we report a case of a GIST in the EGJ successfully treated by laparoscopic intragastric surgery (IGS). CASE PRESENTATION A 58-year-old man with a GIST, which was intragastric growth type, 2.5 cm in diameter, located in the EGJ, and confirmed by upper gastrointestinal endoscope and endoscopic ultrasound-guided fine needle aspiration biopsy. We successfully performed IGS and the patient was discharged without complications. CLINICAL DISCUSSION Using laparoscopic wedge resection by exogastric approach, it is problematic to resect a gastric SMT located at the EGJ because of the difficulty in viewing the surgical field and additional concerns of deformation of the EGJ. We suppose IGS as a suitable method for such tumors. CONCLUSION Laparoscopic IGS for gastric GIST was useful in terms of safety and convenience even though the tumor was in the ECJ.
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Affiliation(s)
- Atsushi Yasuda
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, Osaka 589-8511, Japan.
| | - Yutaka Kimura
- Kindai Nara Hospital, 1248-1 Otoda-cho, Ikoma, Nara 630-0293, Japan
| | - Osamu Shiraishi
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, Osaka 589-8511, Japan
| | - Masayuki Shinkai
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, Osaka 589-8511, Japan
| | - Motohiro Imano
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, Osaka 589-8511, Japan
| | - Takushi Yasuda
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, Osaka 589-8511, Japan
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Teng TZJ, Ishraq F, Chay AFT, Tay KV. Lap-Endo cooperative surgery (LECS) in gastric GIST: updates and future advances. Surg Endosc 2023; 37:1672-1682. [PMID: 36220988 DOI: 10.1007/s00464-022-09691-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 09/25/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND With advancements in the field of laparoscopic and endoscopic techniques leading to improved patient outcomes, open resection has become increasingly outdated for the treatment of gastric gastrointestinal stromal tumours (GIST). This is further superseded with the advent of laparoscopic and endoscopic cooperative surgery (LECS), an amalgamation of the two techniques to further improve results garnered while overcoming prior limitations each had individually. METHODS The electronic databases MEDLINE, Embase and PubMed were reviewed up to August 2021, using terms relating to LECS and gastric GIST. Relevant in-article references not returned in the searches were also considered. RESULTS Advancements in the field of laparoscopic and endoscopic techniques has led to improved patient outcomes, making open resection a thing of the past for gastric GIST. This has become even more apparent with the advent of LECS, coupling two cutting edge techniques to further improve results garnered while overcoming prior limitations each had individually. LECS has gained much favour by reducing surgical margins due to endoscopic visualisation without being limited to smaller tumours, allowing for better anatomical and functional preservation of prior anatomy. Furthermore, hybrid approaches have improved perioperative outcomes, with reduction in procedure time, post-procedure hospital stay and lesser complications. Additionally, subtypes of LECS such as inverted LECS, closed LECS, non-exposed endoscopic wall-inversion surgery (NEWS) and laparoscopy-assisted endoscopic full-thickness resection (LAEFR) have been developed that allows the abdominal cavity to not be exposed to tumour cells and gastric contents by extracting the lesion transorally. CONCLUSIONS LECS and its subtypes being a combination of two advanced techniques shows a synergistic effect that is promising. However, despite all these advantages of enhanced safety and certainty, there remains areas that require further improvement.
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Affiliation(s)
- Thomas Zheng Jie Teng
- General Surgery, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore.
- Undergraduate Medicine, Lee Kong Chian School of Medicine, Singapore, 308232, Singapore.
| | - Farhan Ishraq
- Undergraduate Medicine, Lee Kong Chian School of Medicine, Singapore, 308232, Singapore
| | - Amelia Fang Ting Chay
- Undergraduate Medicine, Lee Kong Chian School of Medicine, Singapore, 308232, Singapore
| | - Kon Voi Tay
- General Surgery, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore
- General Surgery, Woodlands Health Campus, 2 Yishun Central, Singapore, 768024, Singapore
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Liou YJ, Weng SC, Chang PCY, Jiang CB, Lee HC, Chan WT, Ho CY, Wu PS, Yeung CY. Localization and Laparoscopic Excision of Gastric Heterotopic Pancreas in a Child by Endoscopic SPOT ® Tattooing. CHILDREN (BASEL, SWITZERLAND) 2023; 10:201. [PMID: 36832330 PMCID: PMC9954732 DOI: 10.3390/children10020201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/16/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023]
Abstract
Heterotopic pancreas (HP) is defined as pancreatic tissue lacking vascular or anatomic connection with the normal pancreas. Surgical resection is often indicated for symptomatic gastric HP. However, intraoperative identification of gastric HP is often difficult during laparoscopic surgery. Herein, we describe a patient with gastric HP, which was marked with SPOT® dye (GI Supply, Camp Hill, PA, USA). The dye was seen clearly laparoscopically facilitating total excision of the lesion. The final pathology report confirmed the presence of heterotopic pancreatic tissue including pancreatic acini, small pancreatic ducts tissue with islets of Langerhans in the deep gastric submucosal area. There were no postoperative complications, and the patient was symptom-free. To the best of our knowledge, this was the first case report in the literature in which endoscopic tattooing of gastric HP before laparoscopic resection was performed. This method of localization was simple and reliable in children.
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Affiliation(s)
- Yu-Jung Liou
- Department of Pediatrics, Hsinchu Municipal MacKay Children’s Hospital, Hsinchu City 300046, Taiwan
| | - Shu-Chao Weng
- Department of Pediatrics, MacKay Children’s Hospital, Taipei 104217, Taiwan
| | - Paul Chia-Yu Chang
- Division of Pediatric Surgery, Department of Surgery, MacKay Memorial Hospital, Taipei 104217, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 252005, Taiwan
| | - Chuen-Bin Jiang
- Department of Pediatrics, MacKay Children’s Hospital, Taipei 104217, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 252005, Taiwan
| | - Hung-Chang Lee
- Department of Pediatrics, MacKay Children’s Hospital, Taipei 104217, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 252005, Taiwan
| | - Wai-Tao Chan
- Department of Pediatrics, MacKay Children’s Hospital, Taipei 104217, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, Taipei 112021, Taiwan
| | - Cheng-Yu Ho
- Department of Medicine, MacKay Medical College, New Taipei City 252005, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, New Taipei City 251020, Taiwan
| | - Pao-Shu Wu
- MacKay Junior College of Medicine, Nursing, and Management, Taipei 112021, Taiwan
- Department of Pathology, MacKay Memorial Hospital, Taipei 104217, Taiwan
| | - Chun-Yan Yeung
- Department of Pediatrics, Hsinchu Municipal MacKay Children’s Hospital, Hsinchu City 300046, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 252005, Taiwan
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12
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Yip HC, Teh JL, Teoh AYB, Chiu P. Pure endoscopic resection versus laparoscopic assisted procedure for upper gastrointestinal stromal tumors: Perspective from a surgical endoscopist. Dig Endosc 2023; 35:184-194. [PMID: 36318279 DOI: 10.1111/den.14463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/31/2022] [Indexed: 11/27/2022]
Abstract
Management of upper gastrointestinal (UGI) tract gastrointestinal stromal tumor (GIST) has evolved significantly over the past two decades. For GIST size smaller than 5 cm, laparoscopic resection has become the current standard. To avoid postoperative gastric deformity and preserve gastric function, laparoscopic endoscopic cooperative surgery (LECS) was developed and various modifications have been reported and utilized successfully. Pure endoscopic resection techniques have also been reported at a similar period of time, which further push the boundary of incisionless surgery in managing these lesions. Both tunneling and nontunneling exposed type endoscopic full thickness resection are well described procedures for resection of small UGI GIST. In this review, a summary of these procedures is provided, and the pros and cons of each technique from the perspective of a surgical endoscopist are discussed in detail. LECS and endoscopic resection are complementary to each other. The choice of technique should be tailored to the location, morphology, and size of the target lesions, taking into account the experience of the laparoscopic surgeons and endoscopists.
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Affiliation(s)
- Hon Chi Yip
- Division of Upper Gastrointestinal and Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jun Liang Teh
- Division of Upper Gastrointestinal and Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.,National University Health System, Singapore City, Singapore
| | - Anthony Y B Teoh
- Division of Upper Gastrointestinal and Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Philip Chiu
- Division of Upper Gastrointestinal and Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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13
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Yue L, Sun Y, Wang X, Hu W. Advances of endoscopic and surgical management in gastrointestinal stromal tumors. Front Surg 2023; 10:1092997. [PMID: 37123546 PMCID: PMC10130460 DOI: 10.3389/fsurg.2023.1092997] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/24/2023] [Indexed: 05/02/2023] Open
Abstract
As one of the most common mesenchymal malignancies in the digestive system, gastrointestinal stromal tumors (GISTs) occur throughout the alimentary tract with diversified oncological characteristics. With the advent of the tyrosine kinase inhibitor era, the treatment regimens of patients with GISTs have been revolutionized and GISTs have become the paradigm of multidisciplinary therapy. However, surgery resection remains recognized as the potentially curative management for the radical resection and provided with favorable oncological outcomes. The existing available surgery algorithms in clinical practice primarily incorporate open procedure, and endoscopic and laparoscopic surgery together with combined operation techniques. The performance of various surgery methods often refers to the consideration of risk evaluation of recurrence and metastases; the degree of disease progression; size, location, and growth pattern of tumor; general conditions of selected patients; and indications and safety profile of various techniques. In the present review, we summarize the fundamental principle of surgery of GISTs based on risk assessment as well as tumor size, location, and degree of progress with an emphasis on the indications, strengths, and limitations of current surgery techniques.
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Affiliation(s)
- Lei Yue
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, China
| | - Yingchao Sun
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, China
| | - Xinjie Wang
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, China
| | - Weiling Hu
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, China
- Institute of Gastroenterology, Zhejiang University (IGZJU), Hangzhou, China
- Zhejiang University Cancer Center, Hangzhou, China
- Correspondence: Weiling Hu
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14
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Kinami S, Yamada S, Takamura H. Confusion and prospects for carcinogenesis of gastric adenoma and dysplasia: What is the correct answer currently? World J Gastroenterol 2022; 28:6900-6908. [PMID: 36632315 PMCID: PMC9827587 DOI: 10.3748/wjg.v28.i48.6900] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/07/2022] [Accepted: 12/05/2022] [Indexed: 12/26/2022] Open
Abstract
There are differences in the diagnoses of superficial gastric lesions between Japan and other countries. In Japan, superficial gastric lesions are classified as adenoma or cancer. Conversely, outside Japan, the same lesion is classified as low-grade dysplasia (LGD), high-grade dysplasia, or invasive neoplasia. Gastric carcinogenesis occurs mostly de novo, and the adenoma-carcinoma sequence does not appear to be the main pathway of carcinogenesis. Superficial gastric tumors can be roughly divided into the APC mutation type and the TP53 mutation type, which are mutually exclusive. APC-type tumors have low malignancy and develop into LGD, whereas TP53-type tumors have high malignancy and are considered cancerous even if small. For lesions diagnosed as category 3 or 4 in the Vienna classification, it is desirable to perform complete en bloc resection by endoscopic submucosal dissection followed by staging. If there is lymphovascular or submucosal invasion after mucosal resection, additional surgical treatment of gastrectomy with lymph node dissection is required. In such cases, function-preserving curative gastrectomy guided by sentinel lymph node biopsy may be a good alternative.
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Affiliation(s)
- Shinichi Kinami
- Department of Surgical Oncology, Kanazawa Medical University, kahoku-gun 920-0293, Ishikawa, Japan
| | - Sohsuke Yamada
- Department of Clinical Pathology, Kanazawa Medical University, Uchinada 920-0293, Ishikawa, Japan
| | - Hiroyuki Takamura
- Department of Surgical Oncology, Kanazawa Medical University, Kahoku-gun 920-0293, Ishikawa, Japan
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15
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Urakawa S, Holzwanger DJ, Hirashita T, Lowenfeld L, Garrett KA, Pua BB, Milsom JW. Novel percutaneous access to the large intestine using a double-balloon endoluminal platform for excision of a large polyp. Endoscopy 2022; 54:E331-E333. [PMID: 34282589 DOI: 10.1055/a-1516-3533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Shinya Urakawa
- Section of Colon and Rectal Surgery, Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA
| | - Daniel Joseph Holzwanger
- Department of Interventional Radiology, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA
| | - Teijiro Hirashita
- Section of Colon and Rectal Surgery, Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA
| | - Lea Lowenfeld
- Section of Colon and Rectal Surgery, Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA
| | - Kelly A Garrett
- Section of Colon and Rectal Surgery, Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA
| | - Bradley B Pua
- Department of Interventional Radiology, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA
| | - Jeffrey W Milsom
- Section of Colon and Rectal Surgery, Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA
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16
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Akashi Y, Ogawa K, Narasaka T, Enomoto T, Hisakura K, Ohara Y, Owada Y, Furuya K, Shimomura O, Takahashi K, Hashimoto S, Oda T. A scoring system to predict surgical difficulty in minimally invasive surgery for gastric submucosal tumors. Am J Surg 2022; 223:715-721. [PMID: 34315574 DOI: 10.1016/j.amjsurg.2021.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/10/2021] [Accepted: 07/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Various minimally invasive surgery (MIS) procedures are used for gastric submucosal tumors (SMTs), and their technical difficulties vary. Preoperative understanding of difficulties is crucial; however, objective indicators are lacking. METHODS Gastric SMTs requiring MIS (n = 36) were retrospectively analyzed. Preoperative factors were evaluated using a multivariate linear regression analysis. A scoring system was then constructed, and its feasibility was evaluated. RESULTS Three factors were identified and scored based on the weighted contribution for predicting surgical time: tumor location (cardia, score of "2"; posterior wall of fundus, "1"); tumor size (greater than 4 cm, "1"); and tumor growth appearance (intraluminal, "1"). The summed scores could stratify the surgical time stepwise in each score, and patients who scored higher than 3 had larger intraoperative blood loss and a longer hospital stay. CONCLUSION Our scoring system predicted surgical difficulties and may, therefore, be useful in selecting appropriate surgical approaches for gastric SMTs.
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Affiliation(s)
- Yoshimasa Akashi
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, University of Tsukuba, Japan.
| | - Koichi Ogawa
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, University of Tsukuba, Japan
| | | | - Tsuyoshi Enomoto
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, University of Tsukuba, Japan
| | - Katsuji Hisakura
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, University of Tsukuba, Japan
| | - Yusuke Ohara
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, University of Tsukuba, Japan
| | - Yohei Owada
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, University of Tsukuba, Japan
| | - Kinji Furuya
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, University of Tsukuba, Japan
| | - Osamu Shimomura
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, University of Tsukuba, Japan
| | - Kazuhiro Takahashi
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, University of Tsukuba, Japan
| | - Shinji Hashimoto
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, University of Tsukuba, Japan
| | - Tatsuya Oda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, University of Tsukuba, Japan
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17
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Sugiyama Y, Sasaki M, Kouyama M, Tazaki T, Takahashi S, Nakamitsu A. Current treatment strategies and future perspectives for gastrointestinal stromal tumors. World J Gastrointest Pathophysiol 2022; 13:15-33. [PMID: 35116177 PMCID: PMC8788163 DOI: 10.4291/wjgp.v13.i1.15] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/23/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors that originate from the gastrointestinal tract, mostly from the stomach. GISTs are derived from the myenteric interstitial cells of Cajal and are caused by several mutations in the c-kit and platelet-derived growth factor receptor genes. Clinically, GISTs are detected by endoscopic and imaging findings and are diagnosed by immunostaining. Surgery is the first line of treatment, and if the tumor is relatively small, minimally invasive surgery such as laparoscopy is performed. In recent years, neoadjuvant therapy has been administered to patients with GISTs that are suspected of having a large size or infiltration to other organs. Postoperative adjuvant imatinib is the standard therapy for high-risk GISTs. It is important to assess the risk of recurrence after GIST resection. However, the effect of tyrosine kinase inhibitor use will vary by the mutation of c-kit genes and the site of mutation. Furthermore, information regarding gene mutation is indispensable when considering the treatment policy for recurrent GISTs. This article reviews the clinicopathological characteristics of GISTs along with the minimally invasive and multidisciplinary treatment options available for these tumors. The future perspectives for diagnostic and treatment approaches for these tumors have also been discussed.
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Affiliation(s)
- Yoichi Sugiyama
- Department of Gastrointestinal Surgery, JA Hiroshima General Hospital, Hatsukaichi 738-8503, Hiroshima, Japan
| | - Masaru Sasaki
- Department of Gastrointestinal Surgery, JA Hiroshima General Hospital, Hatsukaichi 738-8503, Hiroshima, Japan
| | - Mohei Kouyama
- Department of Gastrointestinal Surgery, JA Hiroshima General Hospital, Hatsukaichi 738-8503, Hiroshima, Japan
| | - Tatsuya Tazaki
- Department of Gastrointestinal Surgery, JA Hiroshima General Hospital, Hatsukaichi 738-8503, Hiroshima, Japan
| | - Shinya Takahashi
- Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan
| | - Atsushi Nakamitsu
- Department of Gastrointestinal Surgery, JA Hiroshima General Hospital, Hatsukaichi 738-8503, Hiroshima, Japan
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18
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Kusunoki C, Hamakawa T, Nishikawa K, Sato H, Imamura S, Miyahara S, Sakano Y, Miyazaki H, Seto H, Ueda R, Toshiyama R, Miyo M, Takahashi Y, Sakai K, Miyake M, Miyamoto A, Kato T, Mori K, Hirao M. Hybrid approach with laparoscopic wall-inversion surgery and single-incision intragastric surgery for intraluminal gastrointestinal stromal tumor: A case report. Asian J Endosc Surg 2021; 14:794-797. [PMID: 33590965 DOI: 10.1111/ases.12927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/25/2021] [Indexed: 11/26/2022]
Abstract
Laparoscopic wedge resection (LWR) for intraluminal gastrointestinal stromal tumor (GIST) leads to excessive resection of normal gastric wall. We report a case of GIST around the cardia successfully treated with full-thickness partial resection using a hybrid approach of laparoscopic surgery and single-incision intragastric surgery (SIIGS). A 69-year-old woman had a 5 cm intraluminal GIST at the posterior wall around the cardia. Submucosal injection of glycerin and indigo carmine was performed with transoral endoscopy. Circumferential seromuscular incision followed by placement of seromuscular sutures to invert the lesion into the stomach was performed under laparoscopy. By SIIGS, resection of the inverted mucosa and retrieval of the tumor were completed. A hybrid approach consisting of laparoscopic wall-inversion surgery and SIIGS was useful for intraluminal GIST and may expand the indications for laparoscopic wall-inversion surgery by removing size limitations.
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Affiliation(s)
- Chikako Kusunoki
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takuya Hamakawa
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Kazuhiro Nishikawa
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Hiromichi Sato
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Sayumi Imamura
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Satoru Miyahara
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Yu Sakano
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Hazuki Miyazaki
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Hiroto Seto
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Ryuta Ueda
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Reishi Toshiyama
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Masaaki Miyo
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Yusuke Takahashi
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Kenji Sakai
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Masakazu Miyake
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Atsushi Miyamoto
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takeshi Kato
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Kiyoshi Mori
- Department of Diagnostic Pathology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Motohiro Hirao
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
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19
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Zhang M, Cai X, Liang C, Weng Y, Yu W. Single-Incision Laparoscopic Intragastric Surgery for Gastric Submucosal Tumors Located Near the Esophagogastric Junction. J Laparoendosc Adv Surg Tech A 2021; 32:360-365. [PMID: 34042503 DOI: 10.1089/lap.2021.0186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Laparoscopic local resection of the stomach for gastric submucosal tumors (SMTs) is widely accepted by surgeons. For SMTs located near the esophagogastric junction (EGJ), simple laparoscopic wedge resection is rarely performed owing to concerns of causing cardia deformities or stenosis. Single-incision laparoscopic intragastric surgery (sLIGS) has been used to treat SMTs located near the EGJ in carefully selected cases. Methods: We modified sLIGS using a subxiphoid incision. Thirteen consecutive patients with intraluminal or intramural growth type gastric SMTs located near the EGJ underwent sLIGS at our institution from July 2018 to April 2020. Results: Thirteen operations were successfully performed using sLIGS, including eight full-thickness resections and five submucosal resections. There were no conversions to an open procedure and all tumors were confirmed to have negative margins on pathology. The mean operation time was 100 ± 10 minutes (range, 85-160 minutes). The mean blood loss was 50 ± 10 mL (range, 50-100 mL). The mean length of postoperative hospital stay was 7 ± 1.5 days (6-10 days). One patient was found to have oozing of blood confirmed by gastroscopy postoperatively and recovered after stopping antiplatelet therapy. Ten cases were gastrointestinal stromal tumor (GIST), two cases were leiomyoma, and one case was neuroendocrine neoplasm. Of the 10 GISTs, 9 were classified as low risk; 1 showed medium risk and the patient received adjuvant imatinib therapy. There were no tumor recurrences during a mean follow-up of 14 ± 4 months (range, 5-25 months). Conclusions: This modified sLIGS for the treatment of the gastric SMTs located near the EGJ is simple and safe. This can be used as an alternative treatment for gastric SMTs near the EGJ.
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Affiliation(s)
- Miaozun Zhang
- Department of Gastrointestinal Surgery, the Li Huili Affiliated Hospital, Ningbo University, Ningbo, Zhejiang Province, China
| | - Xianlei Cai
- Department of Gastrointestinal Surgery, the Li Huili Affiliated Hospital, Ningbo University, Ningbo, Zhejiang Province, China
| | - Chao Liang
- Department of Gastrointestinal Surgery, the Li Huili Affiliated Hospital, Ningbo University, Ningbo, Zhejiang Province, China
| | - Yihui Weng
- Department of Gastrointestinal Surgery, the Li Huili Affiliated Hospital, Ningbo University, Ningbo, Zhejiang Province, China
| | - Weiming Yu
- Department of Gastrointestinal Surgery, the Li Huili Affiliated Hospital, Ningbo University, Ningbo, Zhejiang Province, China
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20
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Pereira Graterol() F, Salazar Marcano F, Venales Barrios Y, Caceres Cauro A. Laparoscopic-endoscopic transgastric (intraluminal) resection of subepithelial lesions in the cardia. A case series. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021. [DOI: 10.1016/j.rgmxen.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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21
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Pereira Graterol F, Salazar Marcano F, Venales Barrios Y, Caceres Cauro A. Laparoscopic-endoscopic transgastric (intraluminal) resection of subepithelial lesions in the cardia. A case series. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2021; 86:202-205. [PMID: 33189485 DOI: 10.1016/j.rgmx.2020.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 04/02/2020] [Accepted: 05/11/2020] [Indexed: 06/11/2023]
Affiliation(s)
- F Pereira Graterol
- Unidad de Cirugía de Mínimo Acceso y Servicio de Cirugía General. Hospital Universitario Dr. Luis Razetti, Barcelona, Venezuela.
| | - F Salazar Marcano
- Unidad de Cirugía de Mínimo Acceso y Servicio de Cirugía General. Hospital Universitario Dr. Luis Razetti, Barcelona, Venezuela
| | - Y Venales Barrios
- Unidad de Cirugía de Mínimo Acceso y Servicio de Cirugía General. Hospital Universitario Dr. Luis Razetti, Barcelona, Venezuela
| | - A Caceres Cauro
- Centro de Investigaciones en Ciencias de la Salud (CICS), Núcleo de Anzoátegui, Universidad de Oriente, Barcelona, Venezuela
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22
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Abstract
BACKGROUND Technological and operative advancements have allowed laparoscopic intragastric surgery (LIGS) to be applied in the treatment of superficial gastric or submucosal lesions. The aim of this study was to evaluate short- and long-term outcomes following LIGS. METHODS From 2000 to 2013, 25 LIGSs were performed for superficial gastric lesions. Clinical records were reviewed retrospectively for peri-operative course and long-term outcomes with particular attention to the oncological follow-up for patients with malignant lesions. RESULTS Nineteen (76%) lesions were located close to the EGJ, three (12%) in the lesser curvature, two (8%) in the posterior wall and one (4%) in the prepyloric-antral region. A multiport technique was used in 15 (60%) patients and a single-access approach in 10 (40%) patients. The median operative time was 140 (50-210) minutes. No conversion to open or conventional laparoscopic surgery was needed. Mortality was nil, and severe morbidity occurred in one (4%) patient. The median length of stay was 6 (3-10) days. Indications of LIGS were adenocarcinoma in 11 (44%) patients, gastrointestinal stromal tumors (GISTs) in 6 (24%) patients and benign lesions in eight (32%) patients. En bloc resection was obtained in 24 (96%) patients with R0 margins in 23 (92%) patients. After a median follow-up of 76 (26-171) months, recurrence was detected in 4 (36%) patients with advanced malignant adenocarcinoma. CONCLUSION LIGS provides an interesting alternative to major gastric and EGJ resection when endoscopic resection is not suitable for highly selected patients with superficial gastric lesions.
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23
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Gillespie C, Ng A, Skipworth R, Leibman S, Smith G. Intragastric laparoscopy for oesophageal eroded mesh removal: An approach to avoid resection. J Minim Access Surg 2020; 16:426-428. [PMID: 32978356 PMCID: PMC7597884 DOI: 10.4103/jmas.jmas_286_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The augmentation of hiatal repair for large hiatus hernia with mesh is controversial. There is some evidence that recurrence rates are less with mesh repair; however, there is a risk of mesh erosion. Complicated erosion may require complex revisional surgery and oesophagogastric resection. We present a novel approach to the treatment of oesophageal mesh erosion, by utilising a combined approach of endoscopy and intragastric laparoscopy. The symptomatic relief from this procedure may obviate the need for foregut resection in some patients.
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Affiliation(s)
- Carla Gillespie
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Ada Ng
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Richard Skipworth
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Steven Leibman
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Garett Smith
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, St Leonards; Sydney Medical School, University of Sydney, Sydney, Australia
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24
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Olmi S, Uccelli M, Oldani A, Cesana G, Ciccarese F, Giorgi R, Villa R, De Carli SM, Zanoni AAG, Rubicondo C, Ismail A. Laparoscopic Surgery of Gastric Cancer with D2 Lymphadenectomy and Omentum Preservation: Our 10 Years Experience. J Laparoendosc Adv Surg Tech A 2020; 30:749-758. [PMID: 32155379 DOI: 10.1089/lap.2019.0781] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Introduction: The debate is still open about laparoscopic treatment of gastric cancer. The aim of this retrospective study is to analyze our short-, medium-, and long-term surgical and oncological results in laparoscopic treatment of gastric cancer with D2 lymphadenectomy and omentum preservation. Materials and Methods: From January 2010 to June 2018, after >150 surgical procedures for gastric cancer performed by minimally invasive approach, we performed 100 laparoscopic subtotal gastrectomies and 38 total gastrectomies, both for early gastric cancer (EGC) and advanced gastric cancer (AGC). We always made a D2 lymphadenectomy or higher. As often as possible, we performed omentum-preserving technique. Primary outcomes analyzed included incidence of medical and surgical complications. Secondary outcomes analyzed were survival probability and incidence of relapse. Every patient read and signed informed consent before surgery. Results: Mean operative time: 2.4 ± 0.7 hours (range 1.2-4.7 hours). Rate of conversions: 14.5% (20/138); intraoperative complications: 1.4% (2/138) and positive resection margins: 6.5% (9/138). Overall incidence of duodenal fistula: 3.6% (5/138). Rate of reoperation was 7.3% (10/138). Postoperative complications according to Clavien-Dindo classification: I 3.6% (5/138); II 13.0% (18/138); III 5.8% (8/138); III B 0.7% (1/138); V 1.4% (2/138). Overall survival with 60 months follow-up was 58%. Overall 60 months incidence of relapse was 44%. Patients with omentum preservation had a lower incidence of relapse than patients with omentectomy (40% versus 57% P = .002). Conclusions: Laparoscopic treatment of gastric cancer with D2 lymphadenectomy and omentum preservation is safe and feasible, both for EGC and for AGC. Although this study has limitations, omentum-preserving technique was associated with a statistically lower recurrence rate.
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Affiliation(s)
- Stefano Olmi
- Department of General and Oncologic Surgery, Centre of Advanced Laparoscopic Surgery, Centre of Bariatric Surgery, San Marco Hospital - GSD, Zingonia, Italy
| | - Matteo Uccelli
- Department of General and Oncologic Surgery, Centre of Advanced Laparoscopic Surgery, Centre of Bariatric Surgery, San Marco Hospital - GSD, Zingonia, Italy
| | - Alberto Oldani
- Department of General and Oncologic Surgery, Centre of Advanced Laparoscopic Surgery, Centre of Bariatric Surgery, San Marco Hospital - GSD, Zingonia, Italy
| | - Giovanni Cesana
- Department of General and Oncologic Surgery, Centre of Advanced Laparoscopic Surgery, Centre of Bariatric Surgery, San Marco Hospital - GSD, Zingonia, Italy
| | - Francesca Ciccarese
- Department of General and Oncologic Surgery, Centre of Advanced Laparoscopic Surgery, Centre of Bariatric Surgery, San Marco Hospital - GSD, Zingonia, Italy
| | - Riccardo Giorgi
- Department of General and Oncologic Surgery, Centre of Advanced Laparoscopic Surgery, Centre of Bariatric Surgery, San Marco Hospital - GSD, Zingonia, Italy
| | - Roberta Villa
- Department of General and Oncologic Surgery, Centre of Advanced Laparoscopic Surgery, Centre of Bariatric Surgery, San Marco Hospital - GSD, Zingonia, Italy
| | - Stefano Maria De Carli
- Department of General and Oncologic Surgery, Centre of Advanced Laparoscopic Surgery, Centre of Bariatric Surgery, San Marco Hospital - GSD, Zingonia, Italy
| | - Adelinda Angela Giulia Zanoni
- Department of General and Oncologic Surgery, Centre of Advanced Laparoscopic Surgery, Centre of Bariatric Surgery, San Marco Hospital - GSD, Zingonia, Italy
| | - Carolina Rubicondo
- Department of General and Oncologic Surgery, Centre of Advanced Laparoscopic Surgery, Centre of Bariatric Surgery, San Marco Hospital - GSD, Zingonia, Italy
| | - Ayman Ismail
- Department of General and Oncologic Surgery, Centre of Advanced Laparoscopic Surgery, Centre of Bariatric Surgery, San Marco Hospital - GSD, Zingonia, Italy
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Solano J, Cadena M, Vergara A, Cabrera LF, Herrera G, Pedraza M. Endoscopic trans gastric assisted surgery for gastric tumors: Case report and description of a new surgical technique. Int J Surg Case Rep 2019; 66:153-157. [PMID: 31846868 PMCID: PMC6920225 DOI: 10.1016/j.ijscr.2019.11.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/15/2019] [Accepted: 11/25/2019] [Indexed: 12/03/2022] Open
Abstract
Laparoscopic intragastric surgery is a possible management for gastrointestinal storm tumors(GIST) treatment. EPATS as percutaneous endoscopic intragastric surgery (PEIGS) can salvage the entire stomach of patients with sub epithelial lesions. Background Minimally invasive intragastric surgery [IGS] was first described by Ohashi in 1995 for early gastric cancer, with 3 trocars placed in the gastric lumen. Prior abdominal surgery is not a contraindication to IGS while the abdominal cavity is not explored, always that exist transilumination. But conversion to laparoscopic and open surgery can be challenging owing to the insufflated stomach and/or small bowel, although gas can be easily released via the gastrostomy. Case presentation A 53-year-old female patient, presented with a sub epithelial gastric antrum lesion confirmed by endoscopic ultrasonography managed with surgical endoscopic percutaneous assisted transgastric technique [EPATS] using a gastrostomy tube and the endoscope. Discussion We have been developing this operation since 2018. Nevertheless, we think EPATS is worthy to master, as PEIGS can salvage the entire stomach of patients with sub epithelial lesions in the lesser curve and in the esophagogastric junction, who otherwise would have to undergo total or proximal gastrectomy. Conclusion We need to perform more cases for future comparative studies with percutaneous endoscopic intragastric surgery [PEIGS] in terms of parameters as pain, inflammation, complications, stenosis, oncological results and cosmesis.
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Affiliation(s)
- Jaime Solano
- Department of General Surgery, Fundación Santa Fe de Bogotá, Bogota, Colombia; Department of Gastroenterology, Fundación Santa Fe de Bogotá, Bogota, Colombia
| | - Manuel Cadena
- Department of General Surgery, Fundación Santa Fe de Bogotá, Bogota, Colombia
| | - Arturo Vergara
- Department of General Surgery, Fundación Santa Fe de Bogotá, Bogota, Colombia
| | - Luis Felipe Cabrera
- Department of General Surgery, Fundación Santa Fe de Bogotá, Bogota, Colombia; Department of General Surgery, Universidad El Bosque, Bogota, Colombia; Department of Medicine, Universidad El Bosque, Bogota, Colombia
| | - Gabriel Herrera
- Oncologist Surgeon, Memorial Sloan-Kettering Cancer Center, Fundación Santa Fe de Bogotá, Colombia
| | - Mauricio Pedraza
- Department of Medicine, Universidad El Bosque, Bogota, Colombia.
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Bures C, Seika P, Veltzke-Schliecker W, Adler A, Kröll D, Zorron R. Intragastric single-port surgery (IGS) accesses the gastric remnant and allows ERCP for common bile duct stones after RYGB: a simple solution for a difficult problem. Surg Obes Relat Dis 2019; 15:1326-1331. [PMID: 31235332 DOI: 10.1016/j.soard.2019.04.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/08/2019] [Accepted: 04/18/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Patients who have undergone a Roux-en-Ygastric bypass (RYGB) and suffer from choledocholithiasis postoperatively pose a medical dilemma. Treatment of the cholestasis can be complicated because of the altered anatomy in these patients. The gastric remnant and duodenum are isolated from the pancreaticobiliary limb, making endoscopic retrograde pancreatography (ERCP) challenging and often impossible. OBJECTIVE To describe a method for safe introduction of the endoscope into the gastric remnant through intragastric single-port surgery (IGS), thus allowing for simultaneous cholecystectomy. SETTING Pilot clinical study. METHODS The present study is a nonrandomized clinical series describing our preliminary results using a transgastric inserted single-port device for ERCP after RYGB. The series includes 8 patients who underwent IGS ERCP after RYGB. RESULTS The technique was successfully applied for intraoperative ERCP through a transgastric inserted single-port device (Gelpoint Mini, Applied Medical, Rancho Santa Margarita, CA). Papilotomy was easily achieved without complications. Average operative time was 144.75 minutes. The patients recovered without complications and could be discharged after a mean of 4.38 days. CONCLUSIONS The novel IGS technique is safe and effective and can be applied to perform ERCP in patients with RYGB anatomy. Transgastric single port ERCP was simple to perform, achieved excellent results, and allowed for endoscopic treatment and cholecystectomy to be performed in a single procedure. The technique can be indicated in patients with complicated gallstone obstruction under altered anatomy after RYGB.
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Affiliation(s)
- Claudia Bures
- Department for Bariatric and Metabolic Surgery, Klinikum Ernst von Bergmann, Potsdam, Germany; Department of General Surgery, Campus Virchow Klinikum, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Philippa Seika
- Department of General Surgery, Campus Virchow Klinikum, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Wilfried Veltzke-Schliecker
- Division Interdisciplinary Endoscopy, Department for Hepatology and Gastroenterology, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Adler
- Division Interdisciplinary Endoscopy, Department for Hepatology and Gastroenterology, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Dino Kröll
- Department of General Surgery, Campus Virchow Klinikum, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ricardo Zorron
- Department for Bariatric and Metabolic Surgery, Klinikum Ernst von Bergmann, Potsdam, Germany.
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Kinami S, Nakamura N, Tomita Y, Miyata T, Fujita H, Ueda N, Kosaka T. Precision surgical approach with lymph-node dissection in early gastric cancer. World J Gastroenterol 2019; 25:1640-1652. [PMID: 31011251 PMCID: PMC6465935 DOI: 10.3748/wjg.v25.i14.1640] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/09/2019] [Accepted: 03/16/2019] [Indexed: 02/06/2023] Open
Abstract
The gravest prognostic factor in early gastric cancer is lymph-node metastasis, with an incidence of about 10% overall. About two-thirds of early gastric cancer patients can be diagnosed as node-negative prior to treatment based on clinic-pathological data. Thus, the tumor can be resected by endoscopic submucosal dissection. In the remaining third, surgical resection is necessary because of the possibility of nodal metastasis. Nevertheless, almost all patients can be cured by gastrectomy with D1+ lymph-node dissection. Laparoscopic or robotic gastrectomy has become widespread in East Asia because perioperative and oncological safety are similar to open surgery. However, after D1+ gastrectomy, functional symptoms may still result. Physicians must strive to minimize post-gastrectomy symptoms and optimize long-term quality of life after this operation. Depending on the location and size of the primary lesion, preservation of the pylorus or cardia should be considered. In addition, the extent of lymph-node dissection can be individualized, and significant gastric-volume preservation can be achieved if sentinel node biopsy is used to distinguish node-negative patients. Though the surgical treatment for early gastric cancer may be less radical than in the past, the operative method itself seems to be still in transition.
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Affiliation(s)
- Shinichi Kinami
- Department of Surgical Oncology, Kanazawa Medical University, Ishikawa 920-0293, Japan
| | - Naohiko Nakamura
- Department of Surgical Oncology, Kanazawa Medical University, Ishikawa 920-0293, Japan
| | - Yasuto Tomita
- Department of Surgical Oncology, Kanazawa Medical University, Ishikawa 920-0293, Japan
| | - Takashi Miyata
- Department of Surgical Oncology, Kanazawa Medical University, Ishikawa 920-0293, Japan
| | - Hideto Fujita
- Department of Surgical Oncology, Kanazawa Medical University, Ishikawa 920-0293, Japan
| | - Nobuhiko Ueda
- Department of Surgical Oncology, Kanazawa Medical University, Ishikawa 920-0293, Japan
| | - Takeo Kosaka
- Department of Surgical Oncology, Kanazawa Medical University, Ishikawa 920-0293, Japan
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Laparoscopic Intragastric Resection: An Alternative Technique for Minimally Invasive Treatment of Gastric Submucosal Tumors. Ann Surg 2019; 267:e12-e16. [PMID: 27926576 DOI: 10.1097/sla.0000000000002099] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To present the technique for and early results of laparoscopic intragastric resection (LIGR). BACKGROUND Treatment of confirmed or suspected submucosal gastric malignancies relies on clear margin resection, for which minimally invasive surgery is widely accepted. However, resection in some localization remains challenging. METHODS We present the steps of LIGR for gastric submucosal tumors (GSMTs). We report the results of LIGR in consecutive patients operated at 2 institutions, including intraoperative, pathologic, 30-day major morbidity and mortality characteristics. RESULTS After laparoscopic access to the abdominal cavity, cuffed gastric ports are placed to approximate the anterior gastric wall to the abdominal wall. A pneumogastrum is created. The tumor is resected in the submucosal plane and the deficit closed with intragastric suturing. Specimen extraction is performed perorally or through a gastrotomy site. In 8 proximal intraluminal GSMTs with median size of 3.1 cm (range: 1.8-6.0 cm), median operative time was 167.5 minutes (range: 120-300 mins). There was no major morbidity and no mortality. All resections were R0. CONCLUSIONS We illustrate the technique of a novel, feasible, and safe minimally invasive approach to GSMTs. LIGR is an alternative to resect challenging GSMTs by limiting surgical invasiveness and preserving gastrointestinal function.
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Tsai TC, Meireles OR. Combined surgical and endoscopic approaches to full-thickness resection. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2019. [DOI: 10.1016/j.tgie.2019.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Aisu Y, Yasukawa D, Kimura Y, Hori T. Laparoscopic and endoscopic cooperative surgery for gastric tumors: Perspective for actual practice and oncological benefits. World J Gastrointest Oncol 2018; 10:381-397. [PMID: 30487950 PMCID: PMC6247108 DOI: 10.4251/wjgo.v10.i11.381] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/15/2018] [Accepted: 10/11/2018] [Indexed: 02/05/2023] Open
Abstract
Laparoscopic and endoscopic cooperative surgery (LECS) is a surgical technique that combines laparoscopic partial gastrectomy and endoscopic submucosal dissection. LECS requires close collaboration between skilled laparoscopic surgeons and experienced endoscopists. For successful LECS, experience alone is not sufficient. Instead, familiarity with the characteristics of both laparoscopic surgery and endoscopic intervention is necessary to overcome various technical problems. LECS was developed mainly as a treatment for gastric submucosal tumors without epithelial lesions, including gastrointestinal stromal tumors (GISTs). Local gastric wall dissection without lymphadenectomy is adequate for the treatment of gastric GISTs. Compared with conventional simple wedge resection with a linear stapler, LECS can provide both optimal surgical margins and oncological benefit that result in functional preservation of the residual stomach. As technical characteristics, however, classic LECS involves intentional opening of the gastric wall, resulting in a risk of tumor dissemination with contamination by gastric juice. Therefore, several modified LECS techniques have been developed to avoid even subtle tumor exposure. Furthermore, LECS for early gastric cancer has been attempted according to the concept of sentinel lymph node dissection. LECS is a prospective treatment for GISTs and might become a future therapeutic option even for early gastric cancer. Interventional endoscopists and laparoscopic surgeons collaboratively explore curative resection. Simultaneous intraluminal approach with endoscopy allows surgeons to optimizes the resection area. LECS, not simple wedge resection, achieves minimally invasive treatment and allows for oncologically precise resection. We herein present detailed tips and pitfalls of LECS and discuss various technical considerations.
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Affiliation(s)
- Yuki Aisu
- Department of Digestive Surgery, Tenri Hospital, Tenri 632-8552, Nara, Japan
| | - Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Yusuke Kimura
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Tomohide Hori
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
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31
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Laparoscopic Endoscopic Cooperative Surgery for Gastrointestinal Stromal Tumors. Surg Laparosc Endosc Percutan Tech 2018; 28:354-358. [PMID: 30395047 DOI: 10.1097/sle.0000000000000591] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
With the development of laparoscopy and digestive endoscopy, multiple laparoscopic and endoscopic cooperative surgeries (LECSs) for gastrointestinal stromal tumors have recently been developed. Classic LECS has been confirmed as a feasible and safe treatment procedure for gastrointestinal stromal tumors with regard to both short-term surgical and long-term oncological outcomes; however, classic LECS has the potential risk of gastric contents or tumor cells spilling into the abdominal cavity because the gastric wall has to be opened during the procedure. Various modified LECS techniques have aimed at further minimizing invasiveness, such as the full-thickness resection method using the nonexposure technique (combination of laparoscopic and endoscopic approaches to neoplasia with a nonexposure technique), nonexposed endoscopic wall-inversion surgery, and closed LECS. This review describes and summarizes the current LECS for gastrointestinal tumor.
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Villano AM, Lofthus A, Watson TJ, Haddad NG, Marshall MB. Minimally Invasive Intragastric Approach to Gastroesophageal Junction Disease. Ann Thorac Surg 2018; 107:412-417. [PMID: 30315795 DOI: 10.1016/j.athoracsur.2018.08.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 08/02/2018] [Accepted: 08/20/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND A minimally invasive intragastric approach to the gastroesophageal junction (GEJ) allows resection of intramural disease while avoiding disruption of the lower esophageal sphincter and vagus nerves. Few surgeons use this approach; thus little is known regarding its indications, feasibility, technical aspects, complication profile, and long-term outcomes. This study reviewed the experience with this technique. METHODS A retrospective review was performed of a prospectively maintained, Institutional Review Board-approved database covering the period from January 1, 2005 to August 1, 2017. Indications, operative details, postoperative complications, and outcomes were assessed. RESULTS There were 12 patients identified. The mean age of these patients was 51.9 years. The indications for resection included 10 symptomatic leiomyomas, one gastrointestinal stromal tumor, and three cancers of the GEJ. Mean and median length of stay were 4.9 and 2.5 days, respectively. There were two postoperative esophageal leaks managed with laparoscopic repair. Of the 3 patients with cancer, 2 underwent an R0 resection, whereas 1 patient underwent an R1 resection. There were no other complications or recurrences. Mean follow-up was 6.0 years (range, 0.5 to 12.6 years); no patients had stricture or symptomatic gastroesophageal reflux on long term follow-up. CONCLUSIONS Resection of selected intramural GEJ disorders through a minimally invasive transgastric approach can be performed safely with acceptable morbidity and good long-term results. The approach allows preservation of the lower esophageal sphincter and vagus nerves, a potential advantage compared with other surgical alternatives to resection in this region.
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Affiliation(s)
- Anthony M Villano
- Department of Surgery, MedStar-Georgetown University Hospital, Washington, DC.
| | - Alexander Lofthus
- Department of Surgery, MedStar-Georgetown University Hospital, Washington, DC
| | - Thomas J Watson
- Department of Thoracic Surgery, MedStar-Georgetown University Hospital, Washington, DC; Regional Department of Surgery and Thoracic Surgery, MedStar Health, Washington, DC
| | - Nadim G Haddad
- Department of Gastroenterology, MedStar-Georgetown University Hospital Washington, DC
| | - M Blair Marshall
- Department of Surgery, MedStar-Georgetown University Hospital, Washington, DC; Department of Thoracic Surgery, MedStar-Georgetown University Hospital, Washington, DC
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Wang J, Yang Z, Zheng J, Hu W, Feng X, Yao X, Li Y. Total-Laparoscopic Intragastric Surgery for Cardia Endogenous Gastric Submucosal Tumors: A Single-Center Short-Term Experience. J Laparoendosc Adv Surg Tech A 2018; 29:374-378. [PMID: 30289344 DOI: 10.1089/lap.2018.0334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Total-laparoscopic intragastric surgery (T-LIGS) has gradually been accepted for the treatment of endogenous gastric submucosal tumors. However, it is difficult to perform T-LIGS when the tumor is located at the esophagogastric junction (cardia endogenous gastric submucosal tumor [CEGSMT]) without special laparoscopic instruments that are not available in most developing countries. We have successfully treated 12 cases of CEGSMTs using conventional laparoscopic instruments and achieved acceptable outcomes. This study was conducted to evaluate the surgical techniques for CEGSMT management. METHODS A retrospective analysis was conducted involving all the CEGSMT patients who were treated with T-LIGS in the General Surgery Department of Guangdong General Hospital from August 2014 to June 2016. RESULTS There were 12 patients successfully treated with T-LIGS. The surgical time ranged from 56 to 108 minutes, and the blood loss was 5-70 mL. The distance to the tumor from the dentate line was 12-24 mm, and the tumor diameter was 17-28 mm. The tumor margins were 9-15 mm, and the eating time was 2-4 days. The drainage tube indwelling time was 2-4 days, and the discharge time was 4-6 days. The follow-up exams revealed no recurrences, dysphagia, acid reflux, or other digestive symptoms. CONCLUSIONS It is safe and feasible to perform T-LIGS using conventional laparoscopic instruments to treat CEGSMTs. We suggest that T-LIGS can be performed for endogenous mucosal tumors within 3 cm from the cardiac dentate line and less than 3 cm in size.
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Affiliation(s)
- Junjiang Wang
- 1 Guangdong General Hospital , Guangdong Academy of Medical Sciences, Guangzhou, China .,2 The Second School of Clinical Medicine, Southern Medical University , Guangzhou, China
| | - Zifeng Yang
- 1 Guangdong General Hospital , Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiabin Zheng
- 1 Guangdong General Hospital , Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Weixian Hu
- 1 Guangdong General Hospital , Guangdong Academy of Medical Sciences, Guangzhou, China .,2 The Second School of Clinical Medicine, Southern Medical University , Guangzhou, China
| | - Xingyu Feng
- 1 Guangdong General Hospital , Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xueqing Yao
- 1 Guangdong General Hospital , Guangdong Academy of Medical Sciences, Guangzhou, China .,2 The Second School of Clinical Medicine, Southern Medical University , Guangzhou, China
| | - Yong Li
- 1 Guangdong General Hospital , Guangdong Academy of Medical Sciences, Guangzhou, China .,2 The Second School of Clinical Medicine, Southern Medical University , Guangzhou, China
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Lyu Z, Yang Z, Wang J, Hu W, Li Y. Totally Laparoscopic Transluminal Resection for Gastrointestinal Stromal Tumors Located at the Cardiac Region. Ann Surg Oncol 2018; 25:2218-2219. [PMID: 29876697 DOI: 10.1245/s10434-018-6482-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND The most common laparoscopic surgery for gastric gastrointestinal stromal tumors (GISTs) currently includes laparoscopic wedge resection, laparoscopic transgastric surgery, and laparoscopic intragastic surgery [Ohashi in Surg Endosc 9:169-171, 1995]. METHODS The clinical data of 10 cases of cardiac endophytic GIST patients who received total laparoscopic intragastric surgery from June 2014 to March 2016 in Guangdong General Hospital were retrospectively analyzed. RESULTS All cases were operated successfully without conversion to laparotomy. Operative time ranged from 59 to 104 min and blood loss was 5-65 mL. All specimens had intact capsules, diameters ranged from 16 to 26 mm, circumferential resection margins were 9-15 mm, and basement resection margins were 4-8 mm. All cases were pathologically diagnosed with GISTs. Time of flatus ranged from 1 to 4 days, time to resume eating was 2-4 days, drainage removal time was 3-4 days, and discharge time was 4-6 days. There was no postoperative hemorrhage, anastomotic leakage, cardiac stenosis, or other complications. All patients showed no swallowing disorders or acid reflux, and there were no signs of recurrence or metastasis in the follow-up period. CONCLUSION Total laparoscopic intragastric treatment for cardiac endophytic GISTs is safe and feasible; however, an advanced laparoscopic surgical technique is required, which needs to be performed with caution.
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Affiliation(s)
- Zejian Lyu
- Department of General Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zifeng Yang
- Department of General Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Junjiang Wang
- Department of General Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Weixian Hu
- Department of General Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yong Li
- Department of General Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
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Abe N, Takeuchi H, Ohki A, Hashimoto Y, Mori T, Sugiyama M. Comparison between endoscopic and laparoscopic removal of gastric submucosal tumor. Dig Endosc 2018; 30 Suppl 1:7-16. [PMID: 29658656 DOI: 10.1111/den.13010] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/05/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM A retrospective study was conducted to compare two resection methods, namely, endoscopic resection (ER) procedures (endoscopic submucosal dissection [ESD], endoscopic muscularis dissection [EMD], and endoscopic full-thickness resection [EFTR]) and laparoscopic resections (LR) (laparoscopic endoscopic cooperative surgery [LECS] and laparoscopic wedge resection). METHODS Seventy-three patients who underwent ER (N = 33: ESD, N = 4; EMD, N = 15; EFTR, N = 14) or LR (N = 39: LECS, N = 16; wedge resection, N = 23) for gastric submucosal tumor (G-SMT) smaller than 50 mm were included in this study. Patient/tumor characteristics and intra/postoperative factors were compared between the ER and LR groups. RESULTS The ER group had a significantly higher percentage of intraluminal growing type of tumor (100% vs 41%) and smaller tumor size (23 vs 33 mm) than the LR group. The ER group had a significantly shorter operative time (93 vs 145 min) and less blood loss (13 vs 30 mL) than the LR group. In the ER group, three patients who had tumors located on the anterior wall of the stomach required laparoscopic closure after EFTR because of difficulty in endoscopic closure of the gastric-wall defect. Postoperative complication rates and duration of postoperative hospital stays did not differ between the two groups. CONCLUSIONS ER may be technically feasible, safe, less invasive, and oncologically appropriate options for selected patients with the intraluminal growing type of G-SMT smaller than 30 mm. EFTR may be more reasonable alternatives to LR in selected patients with a small G-SMT located on the lesser curvature side.
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Affiliation(s)
- Nobutsugu Abe
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Hirohisa Takeuchi
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Atsuko Ohki
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | | | - Toshiyuki Mori
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Masanori Sugiyama
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
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Katsuyama S, Nakajima K, Kurokawa Y, Takahashi T, Miyazaki Y, Makino T, Yamasaki M, Takiguchi S, Mori M, Doki Y. Single-Incision Laparoscopic Intragastric Surgery for Gastric Submucosal Tumor Located Adjacent to Esophagogastric Junction: Report of Four Cases. J Laparoendosc Adv Surg Tech A 2018; 28:78-82. [DOI: 10.1089/lap.2017.0026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Shinsuke Katsuyama
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
- Division of Next Generation Endoscopic Intervention (Project ENGINE), Global Center for Medical Engineering and Informatics, Osaka University, Center of Medical Innovation and Translational Research, Suita, Japan
| | - Kiyokazu Nakajima
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
- Division of Next Generation Endoscopic Intervention (Project ENGINE), Global Center for Medical Engineering and Informatics, Osaka University, Center of Medical Innovation and Translational Research, Suita, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yasuhiro Miyazaki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoki Makino
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Makoto Yamasaki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masaki Mori
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
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38
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Huh YJ, Lee JH. The Advances of Laparoscopic Gastrectomy for Gastric Cancer. Gastroenterol Res Pract 2017; 2017:9278469. [PMID: 29018482 PMCID: PMC5605869 DOI: 10.1155/2017/9278469] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/19/2017] [Indexed: 12/18/2022] Open
Abstract
Laparoscopic gastrectomy is evolving. With the increasing expertise and experience of oncologic surgeons in the minimally invasive surgery for gastric cancer, the indication for laparoscopic gastrectomy is expanding to advanced cases. Many studies have demonstrated the benefits of minimally invasive surgery, including reduced risk of surgery-related injury, reduced blood loss, less pain, and earlier recovery. In order to establish concrete evidence for the suitability of minimal invasive surgery for gastric cancer, many multicenter RCTs, comparing the short- and long-term outcomes of laparoscopic versus open surgery, are in progress. Advances in laparoscopic gastrectomy are moving toward increasingly minimally invasive approaches that enable the improvement of the quality of life of patients, without compromising on oncologic safety.
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Affiliation(s)
- Yeon-Ju Huh
- Department of Surgery, Ewha Womans University Mokdong Hospital, Yangcheon-gu, Seoul 07985, Republic of Korea
| | - Joo-Ho Lee
- Department of Surgery, Ewha Womans University Mokdong Hospital, Yangcheon-gu, Seoul 07985, Republic of Korea
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Siow SL, Mahendran HA, Wong CM. Laparoscopic transgastric resection for intraluminal gastric gastrointestinal stromal tumors located at the posterior wall and near the gastroesophageal junction. Asian J Surg 2017; 40:407-414. [DOI: 10.1016/j.asjsur.2015.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 12/18/2015] [Indexed: 12/24/2022] Open
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Ojima T, Nakamura M, Nakamori M, Takifuji K, Hayata K, Katsuda M, Takei Y, Yamaue H. Laparoscopic and endoscopic cooperative surgery is a feasible treatment procedure for intraluminal gastric gastrointestinal stromal tumors compared to endoscopic intragastric surgery. Surg Endosc 2017; 32:351-357. [DOI: 10.1007/s00464-017-5683-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/19/2017] [Indexed: 12/14/2022]
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Kanehira E, Kanehira AK, Tanida T, Takahashi K, Sasaki K. Percutaneous endoscopic intragastric surgery: an organ preserving approach to submucosal tumors at esophagogastric junction. Transl Gastroenterol Hepatol 2017; 2:48. [PMID: 28616604 DOI: 10.21037/tgh.2017.05.03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 04/07/2017] [Indexed: 12/12/2022] Open
Abstract
As an organ preserving option in the treatment of submucosal tumor found at the esophagogastric junction (EGJ), percutaneous endoscopic intragastric surgery (PEIGS) plays an important role, while it is not commonly performed and there have been very few reports on this unique operation. The current authors have been performing PEIGS since 1993 and have reported on its short- and long-term outcomes from one of the world largest series. Herein its confusing terminology is discussed and techniques of three different types of PEIGS (original PEIGS, single incision PEIGS, and needlescopic PEIGS) are precisely described. Although reports on clinical outcomes of PEIGS have been rarely published, both short-term and long-term outcomes seem acceptable, as far as we review our own experiences and the past literatures. PEIGS needs to be accessed by the data from larger series or RCT to be further justified and spread for the patients with submucosal tumors at EGJ to salvage their stomach.
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Affiliation(s)
- Eiji Kanehira
- Department of Surgery, Medical Topia Soka, Soka, Japan
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Cazauran JB, Mercier F, Pasquer A, Dominici P, Cotte E, Vaudoyer D, Glehen O, Passot G. Intragastric Single-Incision Laparoscopic Surgery for Gastric Leiomyoma: A Stepwise Approach. Ann Surg Oncol 2017; 24:2281. [PMID: 28466402 DOI: 10.1245/s10434-017-5868-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Jean-Baptiste Cazauran
- Service de chirurgie viscérale et oncologique, Hospices Civils de Lyon, Hôpital Lyon Sud, Lyon, France
| | - Frederic Mercier
- Service de chirurgie viscérale et oncologique, Hospices Civils de Lyon, Hôpital Lyon Sud, Lyon, France
| | - Arnaud Pasquer
- Service de chirurgie viscérale et oncologique, Hospices Civils de Lyon, Hôpital Lyon Sud, Lyon, France
| | - Philippe Dominici
- Department of Gastroentérology, Hospices Civils de Lyon, Hôpital Lyon Sud, Lyon, France
| | - Eddy Cotte
- Service de chirurgie viscérale et oncologique, Hospices Civils de Lyon, Hôpital Lyon Sud, Lyon, France
| | - Delphine Vaudoyer
- Service de chirurgie viscérale et oncologique, Hospices Civils de Lyon, Hôpital Lyon Sud, Lyon, France
| | - Olivier Glehen
- Service de chirurgie viscérale et oncologique, Hospices Civils de Lyon, Hôpital Lyon Sud, Lyon, France
| | - Guillaume Passot
- Service de chirurgie viscérale et oncologique, Hospices Civils de Lyon, Hôpital Lyon Sud, Lyon, France. .,Department of Surgical Oncology, Hôpital Lyon Sud, Lyon, Pierre-Bénite, France.
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Nomura E, Okajima K. Function-preserving gastrectomy for gastric cancer in Japan. World J Gastroenterol 2016; 22:5888-5895. [PMID: 27468183 PMCID: PMC4948261 DOI: 10.3748/wjg.v22.i26.5888] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/30/2016] [Accepted: 06/02/2016] [Indexed: 02/06/2023] Open
Abstract
Surgery used to be the only therapy for gastric cancer, and since its ability to cure gastric cancer was the focus of attention, less attention was paid to function-preserving surgery in gastric cancer, though it was studied for gastroduodenal ulcer. Maki et al developed pylorus-preserving gastrectomy for gastric ulcer in 1967. At the same time, the definition of early gastric cancer (EGC) was being considered, histopathological investigations of EGC were carried out, and the validity of modified surgery was sustained. After the development of H2-blockers, the number of operations for gastroduodenal ulcers decreased, and the number of EGC patients increased simultaneously. As a result, the indications for pylorus-preserving gastrectomy for EGC in the middle third of the stomach extended, and various alterations were added. Since then, many kinds of function-preserving gastrectomies have been performed and studied in other fields of gastric cancer, and proximal gastrectomy, jejunal pouch interposition, segmental gastrectomy, and local resection have been performed. On the other hand, from the overall perspective, it can be said that endoscopic resection, which was launched at almost the same time, is the ultimate function-preserving surgery under the current circumstances. The current function-preserving gastrectomies that are often performed and studied are pylorus-preserving gastrectomy and proximal gastrectomy. The reasons for this are that these procedures that can be performed with systemic lymph node dissection, and they include three important elements: (1) reduction of the extent of gastrectomy; (2) preservation of the pylorus; and (3) preservation of the vagal nerve. In addition, these operations are more likely to be performed with a laparoscopic approach as minimally invasive surgery. Of the above-mentioned three elements, reduction of the extent of gastrectomy is the most important in our view. Therefore, we should try to reduce the extent of gastrectomy if curability of the gastric cancer can still be achieved. However, if we preserve a wider residual stomach in function-preserving gastrectomy, we should pay attention to the development of metachronous gastric cancer.
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Kanehira E, Tanida T, Kamei A, Nakagi M, Yoshida T, Touma S. Needlescopic intragastric surgery facilitated by newly developed 2mm instruments. MINIM INVASIV THER 2016; 25:210-4. [PMID: 27228009 DOI: 10.1080/13645706.2016.1181092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Intragastric surgery is a percutaneous endoluminal surgery in the stomach aimed at resection of tumors located at the esophagogastric junction (EGJ). We developed needlescopic intragastric surgery performed via 2 mm, 2 mm, and 5 mm ports (PEIGS-225). MATERIAL AND METHODS In cooperation with Niti-On Co., Ltd. we developed a series of 2 mm instruments including grasping forceps, a cannula, a laparoscope, an electrocautery, scissors, and a needle holder. OPERATIVE TECHNIQUE Two 2 mm trocars and a 5 mm one are inserted into the gastric lumen percutaneously. Intragastric procedures are performed by the instruments brought through those three ports. The specimen is extracted via the esophageal-oral route. The defect in the gastroesophageal wall is closed by hand-suture. After the intragastric procedure, the 5 mm stab wound on the gastric wall is closed by hand-suture, while the 2 mm wounds are left untreated. PATIENTS Between March and August 2015 PEIGS-225 was performed in five patients. RESULTS There was no operative conversion. The mean operation time was 96 minutes. There were no perioperative complications. Pathological findings indicated that the margin was negative in all cases. CONCLUSION Needlescopic intragasric surgery performed via the smallest access (2 mm, 2 mm, 5 mm) is enabled by the 2 mm instruments developed by us.
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Affiliation(s)
| | | | - Aya Kamei
- a Department of Surgery , Medical Topia Soka
| | | | | | - Sachiko Touma
- b Department of Gastroenterology , Medical Topia Soka
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Comparison of minilaparoscopy and single-incision intragastric surgery for gastric submucosal tumor resection in a porcine model. Surg Endosc 2016; 30:4489-98. [PMID: 26895907 DOI: 10.1007/s00464-016-4781-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 01/21/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND The aim of this study was to develop an easy-to-induce and reproducible model of gastric submucosal tumor in swine to compare minilaparoscopy (ML) with single-incision (SI) intragastric surgery. METHODS Twelve healthy female pigs (weight 30.94 ± 2.49 kg) underwent a transparietal injection of sterile alginate at the level of Z-line (n = 6) and at the pre-pyloric area (n = 6) creating a model of gastric submucosal pseudotumor. The operative procedures included intragastric resection with ML and SI approaches of cardiac and pre-pyloric lesions, with gastroscopic assistance. After resection, the gastric mucosal layer was closed using intracorporeal sutures. The operative time, complication rate and clinical evolution after 1 month were compared in the four groups that the pigs were arranged. RESULTS The pseudotumors ranged in size from 3 to 6 cm in diameter. The access of the gastric cavity and resection of the experimental SMP and suturing of the mucosa were performed successfully in 12 animals using both approaches. Mean time to perform the exeresis of gastric cardia tumors was significantly higher in single-incision approach. No significant differences were observed in the surgical time during pyloric surgery. Minilaparoscopic approach reduced significantly the mucosa closure time in esophagogastric and pyloric pseudotumors. One month after, no alterations were shown in the abdominal cavity using exploratory laparotomy. CONCLUSIONS The technical feasibility of performing safe and efficient intragastric approach of submucosal pseudotumors in swine model was verified in this study. Intragastric ML has advantages over SI, namely regarding the reduction in total surgical times and the fewer technical difficulties.
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Intragastric laparoscopic surgery: An option for gastric lesions not resectable by endoscopy. Cir Esp 2015; 94:175-8. [PMID: 26711539 DOI: 10.1016/j.ciresp.2015.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 10/06/2015] [Accepted: 11/03/2015] [Indexed: 11/22/2022]
Abstract
Gastric mucosal and submucosal lesions can be resected by endoscopy, laparoscopy or open surgery. Operative methods have varied depending on the location, endophytic growth and size of the lesion. Interest in minimally invasive surgery has increased and many surgeons are attempting laparoscopic approaches, especially in lesions of the stomach near the esophagogastric junction not amendable to endoscopic removal, because conventional surgery can produce stenosis and distort the postoperative anatomy, and increase morbimortality. We report our experience with laparoscopic intragastric surgery in 3 consecutive patients, with no complications. Laparoscopic intragastric surgery extends the surgeons' armamentarium to resect complex gastric lesions, while offering patients the benefits of minimal access surgery.
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Laparoscopic surgery for gastric cancer: a systematic review. Eur Surg 2015. [DOI: 10.1007/s10353-015-0350-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kanehira E, Kamei A, Umezawa A, Kurita A, Tanida T, Nakagi M. Long-term outcomes of percutaneous endoscopic intragastric surgery in the treatment of gastrointestinal stromal tumors at the esophagogastric junction. Surg Endosc 2015. [DOI: 10.1007/s00464-015-4439-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Vinnicombe Z, Little M, Wan A. Laparo-endoscopic combined approach for excision of gastrointestinal stromal tumour close to the oesophagogastric junction. J Surg Case Rep 2015; 2015:rjv079. [PMID: 26157053 PMCID: PMC4495380 DOI: 10.1093/jscr/rjv079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Tumours close to the oesophagogastric junction (OGJ) are difficult to excise due to high risk of complications. Laparoscopic and endoscopic combined surgery allows minimally invasive access while increasing tumour visualization. Computed tomography (CT) scanning of a 68-year-old female demonstrated a lesion suspicious of a gastrointestinal stromal tumour located 2 cm from the OGJ on the posterior gastric wall. Stapled excision was performed intragastrically and followed by endoscopic removal. Gastroscopy 7 months post-op and follow-up CT scan at 5 years demonstrated no recurrence of the primary tumour and no new disease. Laparoscopic and endoscopic combined approach is a safe and effective method of removing tumours close to the OGJ.
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Affiliation(s)
- Zak Vinnicombe
- Department of Upper GI and Laparoscopic Surgery, St. George's Hospital, London, UK
| | - Max Little
- Department of Upper GI and Laparoscopic Surgery, St. George's Hospital, London, UK
| | - Andrew Wan
- Department of Upper GI and Laparoscopic Surgery, St. George's Hospital, London, UK
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Comparison of the long-term results of patients who underwent laparoscopy versus open distal gastrectomy. Surg Endosc 2015; 30:430-436. [PMID: 25875090 DOI: 10.1007/s00464-015-4215-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 04/06/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Survival data of patients who underwent laparoscopy assisted distal gastrectomy (LADG) compared with those of patients who underwent open distal gastrectomy (ODG) for gastric cancer are rarely presented. We compared long-term outcomes of LADG with those of ODG in patients with EGC who met the current indication for LADG. METHODS A total of 2410 patients with early gastric cancer who underwent curative-intent gastric cancer surgery in three Korean tertiary hospitals between January 2003 and June 2009 were included in this multicenter, retrospective, propensity-score-matched cohort study. Cox proportional hazard regression models were used to evaluate the association between operation methods and survival. RESULTS In the matched cohort, there were no significant differences in overall survival [hazard ratio (HR) for the LADG group 0.990; 95% confidence interval (CI) 0.675-1.453] or recurrence-free survival (HR 0.989; 95% CI 0.480-2.038). The patterns of recurrence were not different between the two groups. The most common pattern of recurrence was liver metastasis followed by metastasis to distant lymph nodes. The rate of complications in the LADG group was higher than that of the ODG group (6.7 vs. 4.6%, P = 0.045). Grade III or worse complications that required surgical intervention or were life-threatening showed a marginal difference between the two groups (1.7 vs. 2.2%, P = 0.052). There were no postoperative mortalities in either group. CONCLUSION Laparoscopy assisted distal gastrectomy for patients with early gastric cancer is feasible in terms of the long-term results including survival and recurrence.
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