Clinical outcomes of laparoscopic and endoscopic cooperative surgery for gastric gastrointestinal stromal tumor

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  • Hanayama Hiroyuki
    Department of Gastrointestinal Tract Surgery, Fukushima Medical University
  • Katagata Masanori
    Department of Gastrointestinal Tract Surgery, Fukushima Medical University
  • Sato Takahiro
    Department of Gastrointestinal Tract Surgery, Fukushima Medical University
  • Nakano Hiroshi
    Department of Gastrointestinal Tract Surgery, Fukushima Medical University
  • Matsumoto Takuro
    Department of Gastrointestinal Tract Surgery, Fukushima Medical University
  • Tada Takeshi
    Department of Gastrointestinal Tract Surgery, Fukushima Medical University
  • Watanabe Yohei
    Department of Gastrointestinal Tract Surgery, Fukushima Medical University
  • Hayase Suguru
    Department of Gastrointestinal Tract Surgery, Fukushima Medical University
  • Okayama Hirokazu
    Department of Gastrointestinal Tract Surgery, Fukushima Medical University
  • Momma Tomoyuki
    Department of Gastrointestinal Tract Surgery, Fukushima Medical University
  • Kato Tsunetaka
    Department of Endoscopy, Fukushima Medical University Hospital
  • Hashimoto Minami
    Department of Endoscopy, Fukushima Medical University Hospital
  • Nakamura Jun
    Department of Endoscopy, Fukushima Medical University Hospital
  • Hikichi Takuto
    Department of Endoscopy, Fukushima Medical University Hospital
  • Saze Zenichiro
    Department of Gastrointestinal Tract Surgery, Fukushima Medical University
  • Kono Koji
    Department of Gastrointestinal Tract Surgery, Fukushima Medical University

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<p>Background:Laparoscopic and endoscopic cooperative surgery (LECS) is a well-recognized surgical procedure for gastric gastrointestinal stromal tumor (GIST). In this report, we describe the clinical outcomes of LECS procedures for gastric GIST in our institution.</p><p>Methods:We performed LECS procedures, including classical LECS, inverted LECS, closed LECS, and combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique (CLEAN-NET), in 40 gastric intraluminal and intramural type GIST patients, whose tumors were ≤ 50 mm in diameter, between September 2012 and December 2020. The patient background, surgical outcomes, postoperative morbidity and mortality, as well as the tumors’ clinicopathological characteristics were analyzed retrospectively.</p><p>Results:Pathological findings showed that most patients had a low or very low risk of tumor recurrence, while one patient had a high risk according to the modified-Fletcher’s classification. The median length of postoperative hospital stay was 7 days. Only one patient had severe postoperative grade III complications according to the Clavien-Dindo (C-D) classification, after closed LECS, but was treated successfully with endoscopic hemostasis for postoperative hemorrhage. The remaining patients treated with LECS did not have severe complications. During the follow-up period (median, 31 months), all patients were disease-free, with no tumor recurrence or metastases.</p><p>Conclusion:LECS is a safe surgical procedure for gastric intraluminal and intramural type GIST ≤ 50 mm in diameter, with good clinical outcomes.</p>

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