Journal of Surgical Oncology | 2019
Laparoscopic Organ-Conserving and Function-Preserving Surgical Resectional Strategy for Gastric Gastro-Intestinal Stromal Tumours (GISTs) is Safe and Effective
Abstract
Background \nGastro-intestinal stromal tumours form the most clinically important and most common group of \nsubmucosal tumours of the stomach. A gain-of-function mutation in genes coding for the KIT tyrosine \nkinase receptor plays a pivotal role in the differentiation and proliferation of GISTs. Surgical resection offers \nthe only chance of cure however the consensus opinion from the European Society of Medical Oncology \n(ESMO) restrict laparoscopic approaches to tumours <2cm in certain anatomical locations provided surgical \noncological principles are observed. This study will assess the safety, effectiveness, and functional outcomes \nof an anatomically-based strategy for the laparoscopic resection of gastric GISTs. \nMethods \nAll symptomatic gastric GISTs diagnosed during a 5 years period were considered for minimal access \nsurgical resection. Lesions were removed according to a structured anatomical approach. The strategy was \ndesigned to conserve the organ and preserve sphincter (lower oesophageal and pyloric) function while \nadhering to oncological principles. A prospective database included patients’ demographics, clinical \nfeatures, imaging, procedure type, operative findings, complications, histopathology, \nimmunohistochemistry, mutation status and risk stratification. Clinical and radiological follow-up was \nrecorded. \nResults \nThirty-two (32) cases of suspected gastric GISTs were considered for minimal access resection during the \nstudy. Twenty-three patients (72%) underwent a laparoscopic wedge resection, six patients (19%) \nunderwent an extra-gastric anterior resection and three patients (9%) underwent trans-gastric posterior \nresection. 97% were histologically confirmed GIST, all achieving R0 excision. 97% were disease free at 20 \nmonths. \nConclusion \nThe authors have demonstrated that an anatomically-based surgical strategy for the laparoscopic resection \nof gastric submucosal tumours is safe and enjoys an oncological and functional success. This, along with \nthe recognised reduced morbidity associated with minimal access surgery lend support to the notion that \nlaparoscopic surgery might be the preferable approach for small to medium sized gastric GISTs.