Analysis Of Effectiveness Of Laparoscopic Resection Of Gastric Stromal Tumors Located On Special Sites

Background:Gastrointestinal stromal tumors (GISTs) originate from the mesenchymal cells of gastrointestinal tract, with a c - kit gene mutations and kit protein (CD117) high expression as biological features. The mutation of the gene expressing type III receptor of tyrosine kinase leads to cells growing out of control and stromal tumor formation.Gastric stromal tumor is accounted for 50%-60% of all GIST,1%-3% of malignant gastric tumors. It can be found on any site of stomach, especially proximal stomach. GISTs are not sensitive to traditional chemotherapy drugs, and surgical resection is the only means to cure that. Compared with open procedure, laparoscopic surgery is advantageous in this field, such as less trauma, rapid recovery, short postoperative hospital stay. In recent years, there are a large number of literature reported the laparoscopic gastric stromal tumor resection. However, tumor located on the special site of stomach, such as posterior gastric wall near cardia or pylorus is difficult to be resected. Few comparisons have been done between different site gastric stromal tumors resected laparoscoping. Most of those gastric stromal tumors can be resected completely under laparoscope, but there are longer operation time, and may cause gastric inlet/outlet narrowing. This study compared the efficacy of different sites of gastric stromal tumor resection, to assess the therapeutic effect, safety and feasibility of the corresponding resecting approach.Objective:To compare the clinical efficacy of different sites of gastric stromal tumor resected by laparoscope, and assess the therapeutic effect, safety and feasibility of the corresponding resecting approach.Method:We reviewed 65 consecutive patients who underwent laparoscopic gastric stromal tumor resection from January 2011 to December 2014 in Qilu Hospital of Shandong University. We divided them into four groups (24 cases of greater curvature group,13 cases of lesser curvature group,17 cases of cardiac group,11 cases of pylorus group) and analyzed the clinical data.Result:Tumors in all the patients were successfully to be resected under laparoscope, with no tumor rupture, no gastric antrum stricture, no conversion to open surgery. And all tumors were confirmed to be gastric stromal tumors via postoperative pathology.The mean operation time of each group as follow:86.7± 19.2 min,140.8+ 64.8 min、139.1±37.1 min、96.7±23.35min. There is significant difference between greater curvature group and lesser curvature group, greater curvature group and cardiac group(p=0.015、p=0.012). The intraoperative blood loss, postoperative complication rate, postoperative hospital stay and recurrence rate of the four groups(greater curvature group vs lesser curvature group vs cardiac group vs pylorus group) had no significant difference (95.0±33.4 vs 140.8±64.8 vs 139.1±37.1 vs 127.3±28.7min,29.1±11.9vs36.7±21.7vs26.4±16.6vs31.7±14.9ml 4.1%vs0%vs6.3%vs0%,8.5±2.8vs6.3±1.5vs7.7±2.9vs7.2±2.1d,4.1%vs0&vs0%vs0%, p>0.05).Conclusion:Tumors located in cardia or lesser curvature need more time to be resected than other sites. There was no significant difference in, complications and postoperative recover time between the four groups. This approach can reach the treatment principle of gastric stromal tumors and avoid gastric inlet/outlet narrowing. So the corresponding resection approach for different site tumors is a safe and feasible surgical treatment approach.