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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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.
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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，鄭成竹，印慨，等. 腹腔鏡胃間質瘤切除56例體會[J]. 腹腔鏡外科雜志， 2008， 13(4)：284-285.
10.	譚玉林，嚴國度，法鎮中，等. 胃間質瘤26例臨床診治分析[J]. 中國癌癥雜志， 2009， 19(7)：536-539.
11.	楊海波. 胃惡性間質瘤致失血性休克1例報道[J]. 中國普外基礎與臨床雜志， 2003， 10(4)：421.
12.	鄭成竹，李際輝. 胃間質瘤的診斷和微創治療[J]. 中國普外基礎與臨床雜志， 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. 小腸間質瘤的診斷與治療[J]. 臨床外科雜志， 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.	羅蘇明，韓振魁，劉妍芳. 胃間質瘤49例臨床資料分析[J]. 新疆醫學， 2008， 38(9)：48-50.
28.	沈清，袁健，張金坤. 胃間質瘤32例臨床診治分析[J]. 中國現代醫藥雜志， 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.	喻學橋，王道榮，陳兆雷，等. 腹腔鏡外科治療胃間質瘤的治療體會[J]. 中國現代普通外科進展， 2009， 12(2)：174-175.
31.	楊平，鄧建中，程龍慶，等. 雙鏡聯合技術在胃間質瘤切除術中的應用[J]. 中華腔鏡外科雜志：電子版， 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，鄭成竹，印慨，等. 腹腔鏡胃間質瘤切除56例體會[J]. 腹腔鏡外科雜志， 2008， 13(4)：284-285.
10. 譚玉林，嚴國度，法鎮中，等. 胃間質瘤26例臨床診治分析[J]. 中國癌癥雜志， 2009， 19(7)：536-539.
11. 楊海波. 胃惡性間質瘤致失血性休克1例報道[J]. 中國普外基礎與臨床雜志， 2003， 10(4)：421.
12. 鄭成竹，李際輝. 胃間質瘤的診斷和微創治療[J]. 中國普外基礎與臨床雜志， 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. 小腸間質瘤的診斷與治療[J]. 臨床外科雜志， 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. 羅蘇明，韓振魁，劉妍芳. 胃間質瘤49例臨床資料分析[J]. 新疆醫學， 2008， 38(9)：48-50.
28. 沈清，袁健，張金坤. 胃間質瘤32例臨床診治分析[J]. 中國現代醫藥雜志， 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. 喻學橋，王道榮，陳兆雷，等. 腹腔鏡外科治療胃間質瘤的治療體會[J]. 中國現代普通外科進展， 2009， 12(2)：174-175.
31. 楊平，鄧建中，程龍慶，等. 雙鏡聯合技術在胃間質瘤切除術中的應用[J]. 中華腔鏡外科雜志：電子版， 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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