Laparoscopy Combined with Gastroscopy in Treatment for Gastric Stromal Tumors （Report of 45 Cases）_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YAO Jing , TAN Xianglong , RONG Shipeng , CHEN Feng , ZHU Yingmei ,  YAO Sheng

Department of General Surgery， The First Affiliated Hospital， General Hospital of PLA， Beijing 100048， China;

Corresponding author：

YAO Sheng, Email: ys848388@yahoo.com.cn

Keywords：

Gastric stromal tumor; Laparoscopy; Gastroscopy

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Objective 　To explore the value of laparoscopy combined with gastroscopy in treatment for gastric stromal tumors.
Method 　The clinical data of 45 patients with gastric stromal tumors performed laparoscopy combined with gastroscopy resection from June 2008 to June 2012 in this hospital were analyzed retrospectively.
Results 　Forty-five patients with gastric stromal tumors were successfully excised by laparoscopy combined with gastroscopy， and the tumors were completely resected and no residual tumor at the edge. The length of surgical incision was about 4-6 cm with an average of 5.1 cm. The mean operation time was 75 min. Postoperative recovery was smooth， no surgery-related comp-
lications occurred. The mean hospital stay was 6.8 d. No recurrence or metastasis happened within the follow-up with an average of 16.5 months. The immunohistochemical examination results：43 cases of CD117 was positive， 32 cases of CD34 was positive， 28 cases of SMA was positive， 2 cases of Desmin was positive， 22 cases of S-100 was positive.
Conclusions 　The treatment of gastric stromal tumors through laparoscopy combined with gastroscopy is safe and effective. The benefits include minimal invasiveness， shorter operation time， and rapid postoperative recovery. The laparoscopy combined with gastroscopy can make more precise resection range， and avoid residual tumor and resection of excessive normal gastric tissue.

Citation： YAO Jing,TAN Xianglong,RONG Shipeng,CHEN Feng,ZHU Yingmei,YAO Sheng,.. Laparoscopy Combined with Gastroscopy in Treatment for Gastric Stromal Tumors （Report of 45 Cases）. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(5): 525-528. doi: Copy

1.	Li VK， Wexner SD， Pulido N， et al. Use of routine intraoperativeendoscopy in elective laparoscopic colorectal surgery：can it furtheravoid anastomotic failure?[J]. Surg Endosc， 2009， 23(11)：2459-2465.
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4.	Onozato Y， Kakizaki S， Ishihara H， et al. Endoscopic submucosal dissection for rectal tumors[J]. Endoscopy， 2007， 39(5)：423-427.
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8.	Nowain A， Bhakta H， Pais S， et al. Gastrointestinal stromal tumors：clinical profile， pathogenesis， treatment strategies and prognosis[J]. J Gastroenterol Hepatol， 2005， 20(6)：818-824.
9.	胡旭光，郑成竹，印慨，等. 腹腔镜胃间质瘤切除56例体会[J]. 腹腔镜外科杂志， 2008， 13(4)：284-285.
10.	谭玉林，严国度，法镇中，等. 胃间质瘤26例临床诊治分析[J]. 中国癌症杂志， 2009， 19(7)：536-539.
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12.	郑成竹，李际辉. 胃间质瘤的诊断和微创治疗[J]. 中国普外基础与临床杂志， 2004， 11(3)：199-200.
13.	Rösch T， Sarbia M， Schumacher B， et al. Attempted endoscopic en bloc resection of mucosal and submucosal tumors using insulated-tip knives：a pilot series[J]. Endoscopy， 2004， 36(9)：788-801.
14.	Krajinovic K， Germer CT， Agaimy A， et al. Outcome after rese-ction of one hundred gastrointestinal stromal tumors[J]. Dig Surg， 2010， 27(4)：313-319.
15.	Miettinen M， Lasota J. Gastrointestinal stromal tumors-definition，clinical， histological， immunohistochemical， and molecular genetic features and differential diagnosis[J]. Virchows Arch， 2001， 438(1)：1-12.
16.	季加孚. 小肠间质瘤的诊断与治疗[J]. 临床外科杂志， 2008， 16(8)：509-511.
17.	Mochizuki Y， Kodera Y， Fujiwara M， et al. Laparoscopic wedge resection for gastrointestinal stromal tumors of the stomach：initialexperience[J]. Surg Today， 2006， 36(4)：341-347.
18.	Schäfer H， Schneider PM， Baldus SE， et al. Combined laparoscopic/endoscopic treatment of gastric stroma tumors[J]. Zentralbl Chir， 2006， 131(3)：206-209.
19.	Silberhumer GR， Hufschmid M， Wrba F， et al. Surgery for gastro-intestinal stromal tumors of the stomach[J]. J Gastrointest Surg， 2009， 13(7)：1213-1219.
20.	Jeong IH， Kim JH， Lee SR， et al. Minimally invasive treatment of gastric gastrointestinal stromal tumors：laparoscopic and endo-scopic approach[J]. Surg Laparosc Endosc Percutan Tech， 2012， 22(3)：244-250.
21.	Tsujimoto H， Yaguchi Y， Kumano I， et al. Successful gastric submucosal tumor resection using laparoscopic and endoscopic cooperative surgery[J]. World J Surg， 2012， 36(2)：327-330.
22.	Wong DC， Wong SK， Leung AL， et al. Combined endolaparoscopic intragastric excision for gastric neoplasms[J]. J Laparoendosc Adv Surg Tech A， 2009， 19(6)：765-770.
23.	Hiki N， Yamamoto Y， Fukunaga T， et al. Laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor dissection[J]. Surg Endosc， 2008， 22(7)：1729-1735.
24.	Wilhelm D， von Delius S， Burian M， et al. Simultaneous use of laparoscopy and endoscopy for minimally invasive resection of gastric subepithelial masses-analysis of 93 interventions[J]. World J Surg， 2008， 32(6)：1021-1028.
25.	Pross M， Wolff S， Schubert D， et al. Combined minimal-invasiveprocedures for resection of benign gastric wall tumors[J]. Zentr-albl Chir， 2003， 128(3)：191-194.
26.	Novitsky YW， Kercher KW， Sing RF， et al. Long-term outcomesof laparoscopic resection of gastric gastrointestinal stromal tumors[J]. Ann Surg， 2006， 243(6)：738-745.
27.	罗苏明，韩振魁，刘妍芳. 胃间质瘤49例临床资料分析[J]. 新疆医学， 2008， 38(9)：48-50.
28.	沈清，袁健，张金坤. 胃间质瘤32例临床诊治分析[J]. 中国现代医药杂志， 2008， 10(7)：28-30.
29.	Privette A， Mccahill L， Borrazzo E， et al. Laparoscopic approa-ches to resection of suspected gastric gastrointestinal stromaltumors based on tumor location[J]. Surg Endosc， 2008， 22(2)：487-494.
30.	喻学桥，王道荣，陈兆雷，等. 腹腔镜外科治疗胃间质瘤的治疗体会[J]. 中国现代普通外科进展， 2009， 12(2)：174-175.
31.	杨平，邓建中，程龙庆，等. 双镜联合技术在胃间质瘤切除术中的应用[J]. 中华腔镜外科杂志：电子版， 2010， 3(2)：178-181.

1. Li VK， Wexner SD， Pulido N， et al. Use of routine intraoperativeendoscopy in elective laparoscopic colorectal surgery：can it furtheravoid anastomotic failure?[J]. Surg Endosc， 2009， 23(11)：2459-2465.
2. Miettinen M， Sobin LH， Lasota J. Gastrointestinal stromaltumors of the stomach：a clinicopathologic， immunohistochemical，and molecular genetic study of 1 765 cases with long-term follow-up[J]. Am J Surg Pathol， 2005， 29(1)：52-68.
3. Blay JY， von Mehren M， Blackstein ME. Perspective on updated treatment guidelines for patients with gastrointestinal stromaltumors[J]. Cancer， 2010， 116(22)：5126-5137.
4. Onozato Y， Kakizaki S， Ishihara H， et al. Endoscopic submucosal dissection for rectal tumors[J]. Endoscopy， 2007， 39(5)：423-427.
5. Taku K， Sano Y， Fu KI， et al. Iatrogenic perforation associated with therapeutic colonoscopy：a multicenter study in Japan[J]. J Gastroenterol Hepatol， 2007， 22(9)：1409-1414.
6. Tanaka S， Oka S， Kaneko I， et al. Endoscopic submucosal dissection for colorectal neoplasia：possibility of standardization[J]. Gastrointest Endosc， 2007， 66(1)：100-107.
7. Bertolini V， Chiaravalli AM， Klersy C， et al. Gastrointestinal stromal tumors-frequency， malignancy， and new prognostic factors：the experience of a single institution[J]. Pathol Res Pract， 2008， 204(4)：219-233.
8. Nowain A， Bhakta H， Pais S， et al. Gastrointestinal stromal tumors：clinical profile， pathogenesis， treatment strategies and prognosis[J]. J Gastroenterol Hepatol， 2005， 20(6)：818-824.
9. 胡旭光，郑成竹，印慨，等. 腹腔镜胃间质瘤切除56例体会[J]. 腹腔镜外科杂志， 2008， 13(4)：284-285.
10. 谭玉林，严国度，法镇中，等. 胃间质瘤26例临床诊治分析[J]. 中国癌症杂志， 2009， 19(7)：536-539.
11. 杨海波. 胃恶性间质瘤致失血性休克1例报道[J]. 中国普外基础与临床杂志， 2003， 10(4)：421.
12. 郑成竹，李际辉. 胃间质瘤的诊断和微创治疗[J]. 中国普外基础与临床杂志， 2004， 11(3)：199-200.
13. Rösch T， Sarbia M， Schumacher B， et al. Attempted endoscopic en bloc resection of mucosal and submucosal tumors using insulated-tip knives：a pilot series[J]. Endoscopy， 2004， 36(9)：788-801.
14. Krajinovic K， Germer CT， Agaimy A， et al. Outcome after rese-ction of one hundred gastrointestinal stromal tumors[J]. Dig Surg， 2010， 27(4)：313-319.
15. Miettinen M， Lasota J. Gastrointestinal stromal tumors-definition，clinical， histological， immunohistochemical， and molecular genetic features and differential diagnosis[J]. Virchows Arch， 2001， 438(1)：1-12.
16. 季加孚. 小肠间质瘤的诊断与治疗[J]. 临床外科杂志， 2008， 16(8)：509-511.
17. Mochizuki Y， Kodera Y， Fujiwara M， et al. Laparoscopic wedge resection for gastrointestinal stromal tumors of the stomach：initialexperience[J]. Surg Today， 2006， 36(4)：341-347.
18. Schäfer H， Schneider PM， Baldus SE， et al. Combined laparoscopic/endoscopic treatment of gastric stroma tumors[J]. Zentralbl Chir， 2006， 131(3)：206-209.
19. Silberhumer GR， Hufschmid M， Wrba F， et al. Surgery for gastro-intestinal stromal tumors of the stomach[J]. J Gastrointest Surg， 2009， 13(7)：1213-1219.
20. Jeong IH， Kim JH， Lee SR， et al. Minimally invasive treatment of gastric gastrointestinal stromal tumors：laparoscopic and endo-scopic approach[J]. Surg Laparosc Endosc Percutan Tech， 2012， 22(3)：244-250.
21. Tsujimoto H， Yaguchi Y， Kumano I， et al. Successful gastric submucosal tumor resection using laparoscopic and endoscopic cooperative surgery[J]. World J Surg， 2012， 36(2)：327-330.
22. Wong DC， Wong SK， Leung AL， et al. Combined endolaparoscopic intragastric excision for gastric neoplasms[J]. J Laparoendosc Adv Surg Tech A， 2009， 19(6)：765-770.
23. Hiki N， Yamamoto Y， Fukunaga T， et al. Laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor dissection[J]. Surg Endosc， 2008， 22(7)：1729-1735.
24. Wilhelm D， von Delius S， Burian M， et al. Simultaneous use of laparoscopy and endoscopy for minimally invasive resection of gastric subepithelial masses-analysis of 93 interventions[J]. World J Surg， 2008， 32(6)：1021-1028.
25. Pross M， Wolff S， Schubert D， et al. Combined minimal-invasiveprocedures for resection of benign gastric wall tumors[J]. Zentr-albl Chir， 2003， 128(3)：191-194.
26. Novitsky YW， Kercher KW， Sing RF， et al. Long-term outcomesof laparoscopic resection of gastric gastrointestinal stromal tumors[J]. Ann Surg， 2006， 243(6)：738-745.
27. 罗苏明，韩振魁，刘妍芳. 胃间质瘤49例临床资料分析[J]. 新疆医学， 2008， 38(9)：48-50.
28. 沈清，袁健，张金坤. 胃间质瘤32例临床诊治分析[J]. 中国现代医药杂志， 2008， 10(7)：28-30.
29. Privette A， Mccahill L， Borrazzo E， et al. Laparoscopic approa-ches to resection of suspected gastric gastrointestinal stromaltumors based on tumor location[J]. Surg Endosc， 2008， 22(2)：487-494.
30. 喻学桥，王道荣，陈兆雷，等. 腹腔镜外科治疗胃间质瘤的治疗体会[J]. 中国现代普通外科进展， 2009， 12(2)：174-175.
31. 杨平，邓建中，程龙庆，等. 双镜联合技术在胃间质瘤切除术中的应用[J]. 中华腔镜外科杂志：电子版， 2010， 3(2)：178-181.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Laparoscopy Combined with Gastroscopy in Treatment for Gastric Stromal Tumors （Report of 45 Cases）

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