Laparoscopic Resection of Gastric GIST and Benign Gastric Tumours: Evolution of a New Technique

Background: Gastrointestinal stromal tumours (GIST) are a distinctive group of mesenchymal neoplasm of the gastrointestinal tract that are best treated by surgical excision without tumour disruption and with a clear resection margin to prevent disease recurrence. However, delivering a posterior gastric tumour through an anterior gastrotomy, laparoscopically, can sometimes risk tumour rupture. We have devised a new technique to avoid this complication.

Method: With the patient in supine position, under a general anaesthetic and using a standard three ports, an anterior gastrotomy was performed and posterior tumour identified. An endobag was introduced through a 10-mm port. The retractable metal ring in endobag was closed around the base of the tumour. The tumour was gently lifted, and an endoscopic linear stapler introduced through another 12-mm port was used to resect the tumour with a cuff of normal gastric tissue. Data were analysed on 22 consecutive patients with gastric GIST who were treated laparoscopically. Intra-operative endoscopy was performed in all cases to aid localisation.

Results: There were 16 posterior tumours, of which 11 were operated by the new technique (using endobag and linear stapler) while 5 were dealt with using the old method (resection and suturing of defect). Median operating time for the new versus old technique was 70 versus 120 min (p < 0.002, Mann-Whitney test). There was no tumour disruption or incomplete resection margin using the new technique for posterior tumours. There were six anterior tumours treated by laparoscopic resection and suture closure of the defect. There was no significant difference in median operating time for anterior versus posterior tumours (80 vs. 75 min).

Conclusion: Gastric GIST can be safely and efficiently resected laparoscopically without rupture or disruption with an adequate resection margin with this technique.