Most appropriately selected gastric gastrointestinal stromal tumors (GISTs) can be safely and effectively removed by general surgeons with basic laparoscopic skills, according to a new study.

Researchers at Thomas Jefferson University Hospital (Philadelphia, PA, USA) conducted a retrospective review of 104 gastric GIST resections since 2002 (of which 58 that were selected for laparoscopic resection) to determine outcomes, derive a framework for selecting candidates for laparoscopic resection, and give suggestions on approaching these tumors. Operative notes were reviewed for the technique employed. Data on tumor location, size, margin status, operative time, and blood loss were collected and analyzed.

The researchers classified the tumors by zone according to their anatomic location. Zone I tumors were included in the area from the gastroesophageal (GE) junction to 3 cm distal along the lesser curve to the angle of His. Zone II tumors made up the majority of GISTs and were located in the fundus and body of the stomach, and zone III tumors were found from the angularis incisura to the pylorus. The results showed that only one resection converted to an open procedure, a case involving a zone III tumor in which the gastric outlet had narrowed; the patient required a formal distal gastrectomy.

When comparing the open group with the laparoscopic group, the team found tumor size significantly smaller in the laparoscopic group due to selection bias based on zone. Blood loss and hospital length of stay were significantly lower in the laparoscopic group as well. Histologic margins were negative in all of the laparoscopic cases. The researchers concluded that preoperative localization allows for optimal operative planning and maximizes the chance of successful laparoscopic removal. The study was published early online on June 19, 2012, in Surgical Endoscopy.

“GISTs do not require an extended resection margin or local lymphadenectomy to improve overall survival and many lesions grow in an exophytic manner. This unique combination of traits makes resecting these tumors via laparoscopy a favorable approach,” said lead author and study presenter chief general surgery resident Michael Pucci, MD. “Most small gastric GISTs can be removed by wedge resection with some variation of technique based on the anatomic location of the tumor.”

GIST are one of the most common mesenchymal tumors of the gastrointestinal tract (1%-3% of all gastrointestinal malignancies), which are typically treated by surgical excision. Most GISTs (70%-80%) are benign. Malignancy is characterized by local invasion and metastases, usually to the liver, omentum, and peritoneum. Most GISTs arise because of a mutation in a gene called c-kit, which encodes a transmembrane receptor for a growth factor termed stem cell factor (SCF).

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