Simultaneous use of gastroscopy and laparoscopy for resection of gastrointestinal stromal tumors

Abstract

Introduction: Gastrointestinal stromal tumors (GIST) are rarely seen mesenchymal tumors originating frominterstitial cells of Cajal. Today, with the wide use of minimally invasive techniques, laparoscopic surgeryhas come to the forefront in GIST surgery. The simultaneous use of laparoscopic gastric wedge resection (LGWR) and intraoperative gastroscopy is a surgical technique that relieves the surgeon. This articlepresents cases in which simultaneous intraoperative gastroscopic observations and LGWR were performedin appropriate GIST cases in one clinic.Materials and Methods: The data of patients who underwent intraoperative gastroscopy and LGWR simultaneously due to GIST at the Kartal Koşuyolu High Specialty Training and Research Hospital between January2014 and December 2015 were evaluated retrospectively.Results: Between January 2014 and December 2015, 12 patients underwent intraoperative gastroscopy andLGWR simultaneously. When the endoscopic and radiological localizations of the tumors were examined,they were in the upper part in 7 patients, the middle part in 3 patients, and the lower part in 2 patients. Themedian tumor size was 4.4 cm (range: 2.7–6.3 cm) and the size of the resected stomach material was 6.7cm (range: 4.5–9 cm). According to the Fletcher risk classifiation, 7 patients were among the low risk groupand 5 patients were considered to be in the moderate risk group.Conclusion: The LGWR procedure for GIST is a reliable and feasible method for centers with advanced laparoscopic surgery experience. The advantages of simultaneous gastroscopy include determining tumor localization, verifying removal of the tumor with negative surgical margins before the development of stenosis,and providing simultaneous evaluation of bleeding or leakage from the stapler line.