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Laparoscopic resection for gastrointestinal stromal tumors in esophagogastric junction (EGJ): how to protect the EGJ

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Abstract

Background

Laparoscopic surgery for gastric gastrointestinal stromal tumors (GISTs) is now widely performed. However, laparoscopic resection of GIST in the esophagogastric junction (EGJ) is technically difficult and rarely reported. Herein, we introduce four fashions of laparoscopic resection for EGJ-GIST.

Methods

A retrospective review of 42 consecutive patients with EGJ-GIST who underwent attempted laparoscopic surgery was conducted. EGJ-GIST was defined as GIST with an upper border of less than 5 cm from the esophagogastric line. Four fashions of laparoscopic resection were performed: fashion A, laparoscopic wedge resection using linear stapler; fashion B, laparoscopic complete resection by opening the stomach wall and closing with suture or linear stapler; fashion C, laparoscopic mucosa-preserving resection; and fashion D, laparoscopic proximal gastrectomy with pyloroplasty and gastric plication. Clinicopathologic characteristics, operative course, and short-term and long-term outcomes were analyzed.

Results

All procedures were completed successfully without operative complications. In 24 of 42 (57.1%) patients, tumors were located in the fundus or greater curvature. Out of those, 70.8% (17/24) received fashion A and 29.2% (7/24) received fashion B. Tumors in 16 of 42 (38.1%) patients were located in the lesser curvature. Of those, 81.3% (13/16) underwent fashion B and 18.7% (3/16) underwent fashion D. One tumor in the anterior stomach wall and one in the posterior wall received fashion C. The mean operative time was 103.8 ± 22.1 min and the mean estimated blood loss was 22.4 ± 13.5 ml. The mean time to flatus was 40.3 ± 12.9 h and the time to fluid intake was 43.2 ± 14.3 h. The mean hospital stay was 4.8 ± 2.1 days.

Conclusions

Laparoscopic surgery for EGJ-GIST is safe and feasible. The selection of various laparoscopic resection fashions should be chosen based on tumor location and the surgeon’s experience.

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Acknowledgements

The authors would like to give special thanks to two medical students, Kuangda Shan, and Nancy Ha, from the University of Iowa, Carver College of Medicine for their valuable assistance in the English rewriting of the manuscript.

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    Authors and Affiliations

    1. Department of Gastrointestinal Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No. 111, 510120, Guangzhou, China

      Wenjun Xiong, Yansheng Zheng, Lijie Luo, Yaobin He, Hongming Li, Dechang Diao, Liaonan Zou, Jin Wan & Wei Wang

    2. Department of General Surgery, The Second Hospital of Jilin University, Ziqiang Street No. 218, 130041, Jilin, China

      Jiaming Zhu

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    Wenjun Xiong, Jiaming Zhu, Yansheng Zheng, Lijie Luo, Yaobin He, Hongming Li, Dechang Diao, Liaonan Zou, Jin Wan, and Wei Wang have no conflicts of interest or financial ties to disclose.

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    Wenjun Xiong and Jiaming Zhu contributed equally to this work in the design of the study and preparation of the manuscript and should be both considered as co-first authors.

    Jin Wan and Wei Wang contributed equally to this work in the technique design, materials collection, analysis, interpretation of data and revising the article, they should be the co-correspondence authors.

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    Xiong, W., Zhu, J., Zheng, Y. et al. Laparoscopic resection for gastrointestinal stromal tumors in esophagogastric junction (EGJ): how to protect the EGJ. Surg Endosc 32, 983–989 (2018). https://doi.org/10.1007/s00464-017-5776-6

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