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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(09): E1254-E1260
DOI: 10.1055/a-1895-9507
Original article

Excellent oncological outcomes besides short-term safety of laparoscopic and endoscopic cooperative surgery for gastric gastrointestinal stromal tumor

Hiroki Harada
1   Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
2   Department of Upper-gastrointestinal Surgery, Kitasato University School of Medicine, Kanagawa, Japan
,
Manabu Ohashi
1   Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
,
Naoki Hiki
2   Department of Upper-gastrointestinal Surgery, Kitasato University School of Medicine, Kanagawa, Japan
,
Junko Fujisaki
3   Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
,
Toshiaki Hirasawa
3   Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
,
Yorimasa Yamamoto
4   Division of Gastroenterology, Endoscopy Center, Showa University Fujigaoka Hospital, Yokohama, Japan
,
Rie Makuuchi
1   Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
,
Satoshi Ida
1   Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
,
Masaru Hayami
1   Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
,
Koshi Kumagai
1   Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
,
Takeshi Sano
1   Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
,
Souya Nunobe
1   Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Abstract

Background and study aims Laparoscopic and endoscopic cooperative surgery (LECS) for gastric submucosal tumor was developed as a type of minimal local resection and is now widely used in Asian countries. However, the oncological safety of LECS for gastric gastrointestinal stromal tumor (GIST) remains unclear. LECS has potential oncology-related problems that may influence survival outcomes. Furthermore, the feasibility and safety of LECS have not yet been fully established.

Patients and methods Patients who were intended to undergo LECS for gastric GIST from 2006 to 2020 were retrospectively selected. The indication for LECS was determined according to the guidelines. The completion of LECS, complications, and survival outcomes of the patients were analyzed.

Results Two hundred fifty-nine patients were eligible in this study. According to intraoperative findings, 44 patients underwent local resection without luminal endoscopic procedures. Of the remaining 215 patients, 213 completely underwent LECS, which corresponds to a completion rate of 99.1 %. Six patients (2.8 %) had postoperative complications of Clavien-Dindo classification grade II or higher. Delayed gastric emptying was most commonly found in four patients (1.9 %). Old age (P = 0.0349), female sex (P = 0.0095), tumor located in the lesser curvature (P = 0.0015), and large tumor diameter (P = 0.0232) were significantly more common in patients with complications. The 3-year overall and disease-specific survival rates were 99 % and 100 %, respectively, in 215 patients who were intended to undergo LECS.

Conclusions Despite several oncological concerns, LECS for gastric GIST is oncologically safe besides a feasible and safe procedure in the short-term.



Publication History

Received: 01 February 2022

Accepted after revision: 05 July 2022

Article published online:
14 September 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Miettinen M, Lasota J. Gastrointestinal stromal tumors: review on morphology, molecular pathology, prognosis, and differential diagnosis. Arch Pathol Lab Med 2006; 130: 1466-1478
    CrossrefPubMedGoogle Scholar
  • 2 Joensuu H, Hohenberger P, Corless CL. Gastrointestinal stromal tumour. Lancet 2013; 382: 973-983
    CrossrefPubMedGoogle Scholar
  • 3 Mucciarini C, Rossi G, Bertolini F. et al. Incidence and clinicopathologic features of gastrointestinal stromal tumors: a population‐based study. BMC Cancer 2007; 20: 230
    CrossrefPubMedGoogle Scholar
  • 4 Joensuu H, Fletcher C, Dimitrijevic S. et al. Management of malignant gastrointestinal stromal tumors. Lancet Oncol 2002; 3: 655-664
    CrossrefPubMedGoogle Scholar
  • 5 DeMatteo RP, Lewis JJ, Leung D. et al. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 2000; 231: 51-58
    CrossrefPubMedGoogle Scholar
  • 6 Honda M, Hiki N, Nunobe S. et al. Long-term and surgical outcomes of laparoscopic surgery for gastric gastrointestinal stromal tumors. Surg Endosc 2014; 28: 2317-2322
    CrossrefPubMedGoogle Scholar
  • 7 Ye X, Kang WM, Yu JC. et al. Comparison of short- and long-term outcomes of laparoscopic vs open resection for gastric gastrointestinal stromal tumors. World J Gastroenterol 2017; 23: 4595-4603
    CrossrefPubMedGoogle Scholar
  • 8 Yang Z, Feng X, Zhang P. et al. Clinicopathological features and prognosis of 276 cases of primary small (≤ 2 cm) gastric gastrointestinal stromal tumors: a multicenter data review. Surg Endosc 2019; 33: 2982-2990
    CrossrefPubMedGoogle Scholar
  • 9 Askari A, Brittain R, Hilmi M. et al. Unusual presentations, management and outcomes of gastric stromal tumors: a single-center case series. Ann Gastroenterol 2021; 34: 26-32
    PubMedGoogle Scholar
  • 10 Hiki N, Yamamoto Y, Fukunaga T. et al. Laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor dissection. Surg Endosc 2008; 22: 1729-1735
    CrossrefPubMedGoogle Scholar
  • 11 Matsuda T, Nunobe S, Kosuge T. et al. Laparoscopic and luminal endoscopic cooperative surgery can be a standard treatment for submucosal tumors of the stomach: a retrospective multicenter study. Endoscopy 2017; 49: 476-483
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Matsuda T, Hiki N, Nunobe S. et al. Feasibility of laparoscopic and endoscopic cooperative surgery for gastric submucosal tumors (with video). Gastrointest Endosc 2016; 84: 47-52
    CrossrefPubMedGoogle Scholar
  • 13 Nunobe S, Hiki N, Gotoda T. et al. Successful application of laparoscopic and endoscopic cooperative surgery (LECS) for a lateral-spreading mucosal gastric cancer. Gastric Cancer 2012; 15: 338-342
    CrossrefPubMedGoogle Scholar
  • 14 Aoyama J, Kawakubo H, Matsuda S. et al. Clinical outcomes of laparoscopic and endoscopic cooperative surgery for submucosal tumors on the esophagogastric junction: a retrospective single-center analysis. Gastric Cancer 2020; 23: 1084-1090
    CrossrefPubMedGoogle Scholar
  • 15 Eom BW, Kim CG, Kook MC. et al. Feasibility of non-exposure simple suturing endoscopic full-thickness resection in comparison with laparoscopic endoscopic cooperative surgery for gastric subepithelial tumors: results of two independent prospective trials. Cancers (Basel) 2021; 13: 1858
    CrossrefPubMedGoogle Scholar
  • 16 Mahawongkajit P, Chanswangphuvana P. Laparoscopy-assisted endoscopic full-thickness resection of upper gastrointestinal subepithelial tumors: A single-center early experience. Mol Clin Oncol 2020; 12: 461-467
    PubMedGoogle Scholar
  • 17 Nishida T, Hirota S, Yanagisawa A. et al. Clinical practice guidelines for gastrointestinal stromal tumor (GIST) in Japan: English version. Int J Clin Oncol 2008; 13: 416-430
    CrossrefPubMedGoogle Scholar
  • 18 Kanda M, Mizuno A, Tanaka C. et al. Nutritional predictors for postoperative short-term and long-term outcomes of patients with gastric cancer. Medicine 2016; 95: e3781
    CrossrefPubMedGoogle Scholar
  • 19 Clavien PA, Strasberg SM. Severity grading of surgical complications. Ann Surg 2009; 250: 197-198
    CrossrefPubMedGoogle Scholar
  • 20 Blay JY, Bonvalot S, Casali P. et al. Consensus meeting for the management of gastrointestinal stromal tumors. Report of the GIST Consensus Conference of 20-21 March 2004, under the auspices of ESMO. Ann Oncol 2005; 16: 566-578
    CrossrefPubMedGoogle Scholar
  • 21 Joensuu H. Risk stratification of patients diagnosed with gastrointestinal stromal tumor. Hum Pathol 2008; 39: 1411-1419
    CrossrefPubMedGoogle Scholar
  • 22 Rutkowski P, Bylina E, Wozniak A. et al. Validation of the Joensuu risk criteria for primary resectable gastrointestinal stromal tumour – the impact of tumour rupture on patient outcomes. Eur J Surg Oncol 2011; 37: 890-896
    CrossrefPubMedGoogle Scholar
  • 23 Yi SQ, Ru F, Ohta T. et al. Surgical anatomy of the innervation of pylorus in human and Suncus murinus, in relation to surgical technique for pylorus-preserving pancreaticoduodenectomy. World J Gastroenterol 2006; 12: 2209-2216
    CrossrefPubMedGoogle Scholar
  • 24 Kim DK, Hindenburg AA, Sharma SK. et al. Is pylorospasm a cause of delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy?. Ann Surg Oncol 2005; 12: 222-227
    CrossrefPubMedGoogle Scholar
  • 25 Kramer K, Knippschild U, Mayer B. et al. Impact of age and gender on tumor related prognosis in gastrointestinal stromal tumors (GIST). BMC Cancer 2015; 15: 57
    CrossrefPubMedGoogle Scholar
  • 26 Park CH, Kim GH, Lee BE. et al. Two staging systems for gastrointestinal stromal tumors in the stomach: which is better?. BMC Gastroenterol 2017; 17: 141
    CrossrefPubMedGoogle Scholar