Elsevier

Surgery

Volume 160, Issue 4, October 2016, Pages 1038-1048
Surgery

Central Surgical Association
Application of an individualized operative strategy for wedge resection of gastric gastrointestinal stromal tumors: Effectiveness for tumors in difficult locations

https://doi.org/10.1016/j.surg.2016.06.004Get rights and content

Background

There is some concern that wedge resection of gastric gastrointestinal stromal tumors is not feasible in certain anatomic locations, such as the cardia or antrum. We sought to review our experience with treatment of gastric gastrointestinal stromal tumors with a particular focus on nonanatomic wedge resections in these challenging locations.

Methods

Patients undergoing resection of gastrointestinal stromal tumors from 2000–2014 at the Montreal General Hospital were identified from a prospectively collected database, and outcomes were tabulated. An individualized operative strategy was used to guide resection based on tumor location, size, and characteristics. Disease-free survival and overall survival analyzed using the Kaplan-Meier method. Data are presented as median (range).

Results

We identified 59 patients who underwent operative resection for gastric gastrointestinal stromal tumors. Tumor location was fundus/body/greater curvature in 35 (59%) patients, lesser curvature in 8 (14%) patients, antrum in 8 (14%) patients, and cardia in 8 (14%) patients. Median tumor size was 4.5 cm (1.4–25 cm). The majority of cardia and antral lesions were removed with wedge resections (14/16, 87%). For cardial and antral tumors, on-table gastroscopy was used to guide the operative approach and prevent narrowing of the Gastroesophageal junction or pylorus in all patients undergoing wedge resection. Negative pathologic margins were achieved in all patients. The 5-year disease-free survival was 91% and 5-year overall survival was 95%.

Conclusion

When selected appropriately, and under the guidance of on-table gastroscopy, laparoscopic nonanatomic wedge resection can be performed successfully in the majority of cases, even for gastrointestinal stromal tumors near the GEJ or pylorus, with excellent oncologic outcomes.

Section snippets

Patient selection

All patients undergoing resection of gastric GISTs from 2000–2014 at the Montreal General Hospital of the McGill University Health Centre were identified from a prospectively collected database. These were then cross-referenced against the operative booking database of all gastric resections performed during the study period. Pathology records of these patients were reviewed to identify all patients who had pathology-proven gastric resection for GIST. In total, 59 patients met inclusion

Results

From 2000–2014, a total of 59 patients were identified who had undergone operative resection for pathologically proven gastric GIST (median age, 65 [34–83] years; 26 [44%] male). The procedure was completed laparoscopically in 41 (71%) patients, open in 14 (24%) patients, and converted to open in 3 (5.1%) patients. Wedge resection was performed in 54 (92%) patients, and anatomic resection in 5 (8.5%) patients. The characteristics of study participants and operative approach are summarized in

Discussion

This study summarizes 14 years of experience at a single, tertiary care center regarding the operative techniques of gastric GIST resection across a wide range of tumor sizes and locations. Laparoscopic and nonanatomic resection were achieved in the vast majority of cases, in accordance with currently accepted preferred resection strategies.14 Nonanatomic resection was achieved for the majority of tumors (14/16) at the antrum and cardia. In conjunction with proper long-term follow-up and

References (27)

  • R.P. DeMatteo et al.

    Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival

    Ann Surg

    (2000)
  • G. Demetri et al.

    NCCN Task Force Report: update on the management of patients with gastrointestinal stromal tumors

    J Natl Compr Canc Netw

    (2010)
  • R. DeMatteo et al.

    Long-term results of adjuvant imatinib mesylate in localized, high-risk, primary gastrointestinal stromal tumor (GIST): ACOSOG Z9000 (Alliance) intergroup phase 2 trial

    Ann Surg

    (2013)
  • Cited by (0)

    Carmen L. Mueller and Josef Braun contributed equally to this work.

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