Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Mar;29(1):1-4.
doi: 10.1590/0102-6720201600010001.

LAPAROSCOPIC RESECTION OF GASTROINTESTINAL STROMAL TUMORS (GIST)

[Article in English, Portuguese]
Marcelo de Paula Loureiro  1 , Rômulo Augusto Andrade de Almeida  2 , Christiano Marlo Paggi Claus  1 , Eduardo Aimoré Bonin  1 , Antônio Moris Cury-Filho  1 , Daniellson Dimbarre  1 , Marco Aurélio Raeder da Costa  1 , Marcílio Lisboa Vital  1
Affiliations

LAPAROSCOPIC RESECTION OF GASTROINTESTINAL STROMAL TUMORS (GIST)

[Article in English, Portuguese]
Marcelo de Paula Loureiro et al. Arq Bras Cir Dig. 2016 Mar.

Abstract
in English, Portuguese

Background: Gastrointestinal mesenchymal or stromal tumors (GIST) are lesions originated on digestive tract walls, which are treated by surgical resection. Several laparoscopic techniques, from gastrectomies to segmental resections, have been used successfully.

Aim: Describe a single center experience on laparoscopic GIST resection.

Method: Charts of 15 operated patients were retrospectively reviewed. Thirteen had gastric lesions, of which ten were sub epithelial, ranging from 2-8 cm; and three were pure exofitic growing lesions. The remaining two patients had small bowel lesions. Surgical laparoscopic treatment consisted of two distal gastrectomies, 11 wedge gastric resections and two segmental enterectomies. Mechanical suture was used in the majority of patients except on six, which underwent resection and closure using manual absorbable sutures. There were no conversions to open technique.

Results: Mean operative time was 1h 29 min±92 (40-420 min). Average lenght of hospital stay was three days (2-6 days). There were no leaks, postoperative bleeding or need for reintervention. Mean postoperative follow-up was 38±17 months (6-60 months). Three patients underwent adjuvant Imatinib treatment, one for recurrence five months postoperatively and two for tumors with moderate risk for recurrence .

Conclusion: Laparoscopic GIST resection, not only for small lesions but also for tumors above 5 cm, is safe and acceptable technique.

Os tumores estromais ou mesenquimais gastrointetinais (GIST) são lesões originárias da parede do tubo digestivo cujo tratamento requer remoção cirúrgica. Diversas técnicas por via laparoscópica - gastrectomias e ressecções segmentares - têm sido empregadas com sucesso.

Apresentar a experiência de um serviço de cirurgia com ressecção laparoscópica de GIST.

Foram avaliados 15 pacientes com GIST operados revisados retrospectivamente. Treze tiveram lesões gástricas, das quais 10 eram subepiteliais entre 2-8 cm. Três eram lesões exofíticas puras. Dois apresentavam lesões no intestino delgado. O tratamento cirúrgico por laparoscopia consistiu de duas gastrectomias distais; 11 ressecções gástricas em cunha e duas enterectomias segmentares. Sutura mecânica foi utilizada na maioria dos doentes, exceto em seis com suturas absorvíveis manuais. Não houve conversões para laparotomia.

O tempo médio das operações foi de 89±92 min (40-420). A hospitalização média foi de três dias (2-6). Não houve fístula, sangramento pós-operatório ou necessidade de reintervenção por complicação cirúrgica. O seguimento médio pós-operatorio foi de 38±17 meses (6-60). Três pacientes foram encaminhados para terapia adjuvante com mesilato de imatinib, um deles por recidiva precoce aos cinco meses, e os outros dois por apresentarem risco moderado para recidiva.

A ressecção laparoscópica de GIST, mesmo os maiores de 5 cm, é procedimento factível e seguro.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest: none

Figures

Figure 1
Figure 1. - A) Posterior gastric wall accessed through the anterior gastric wall with GIST wedge resection using mechanical laparoscopic sutures; B) anterior gastric wall GIST wedge-resected using monopolar energy followed by gastrorrhaphy
Figure 2
Figure 2. - Surgical margin resection after confirmed positive margin
See this image and copyright information in PMC

References

    1. Barros F, Nahoum, Guilherme PA, Bruno J. Treatment of gastrointestinal stromal tumor (GIST) during bariatric surgery. Rev Col Bras Cir. 2015;42(1):67–68. - PubMed
    1. Blackstein ME, Blay JY, Corless C, Driman DK, Riddell R, Soulières D. Gastrointestinal stromal tumours: consensus statement on diagnosis and treatment. Can J Gastroenterol. 2006;20(3):157–163. - PMC - PubMed
    1. Casali PG, Jost L, Reichardt P, Schlemmer M, Blay JY. Gastrointestinal stromal tumours: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol. 2009;20:64–67. - PubMed
    1. Cruz RJ, Júnior, Glyniadakis N, Cavalcante RN, Cepeda LA, Vincenzi R. Hemorragia digestiva provocada por tumor estromal gastrointestinal avançado de duodeno. Arq Bras Cir Dig. 2007;20(4):290–292.
    1. Dematteo RP, Gold JS, Saran L, Gönen M, Liau KH, Maki RG. Tumor mitotic rate, size, and location independenly predict recurrence after resection of primary gastrointestinal stromal tumor (GIST) Cancer. 2008;112(3):608–615. - PubMed