TUNNEL DISSECTION AS A TREATMENT OPTION IN PATIENTS WITH GASTROINTESTINAL STROMAL TUMORS

Aims:

To evaluate the effectiveness of submucosal tunnel dissection in treating patients with gastrointestinal stromal tumors.

Methods:

Since March 2014 twenty four patients with gastrointestinal stromal tumors were operated using a tunneling method. There were three men and twenty one women. Twenty seven tumors were removed in total. The average age of patients was 62.8 years. We operated patients with primary tumors, as well as patients who were under follow-up for a long time. The indication for surgery for the latter was a negative dynamics according to endosonography including increasing in size and changes in structure of the tumor. The average size of tumor was nineteen mm. The main point of surgery is the formation of tunnel in submucosal space through mucosal incision and enucleation of tumor preserving the integrity of capsule. Patients were maintained in the supine position, and general anesthesia was administered using mechanical ventilation.

Results:

Intraoperative carboxyperitoneum occurred in four cases, it was resolved by abdominal decompression with the help of Verres needle. No other intraoperative or postoperative complications were observed. Patients were discharged the next day after surgery. Immunohistochemistry assay demonstrated sixteen gastrointestinal stromal tumors (nine specimens of low risk, seven of intermediate risk). In eight patients immunohistochemistry confirmed leiomyomas.

Conclusions:

Endoscopic tunnel operations are technically feasible and can be used as a surgical treatment of subepithelial tumors of myogenic origin. Moreover, a minimal access significantly reduces the number of complications and a period of patients' rehabilitation after operation.