Endoscopy 2018; 50(02): 178-179
DOI: 10.1055/s-0043-121136
E-Videos
© Georg Thieme Verlag KG Stuttgart · New York

Laparoscopic and endoscopic cooperative surgery for difficult resection of posterior esophagogastric junction gastrointestinal stromal tumors

Jean-Michel Gonzalez
1   Department of Gastroenterology, Assistance Publique Hopitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
,
Antoine Debourdeau
1   Department of Gastroenterology, Assistance Publique Hopitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
,
Guillaume Philouze
1   Department of Gastroenterology, Assistance Publique Hopitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
,
Laura Beyer
2   Department of Digestive Surgery, Assistance Publique Hopitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
,
Stéphane Berdah
2   Department of Digestive Surgery, Assistance Publique Hopitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
,
Marc Barthet
1   Department of Gastroenterology, Assistance Publique Hopitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
› Institutsangaben
Weitere Informationen

Corresponding author

Jean-Michel Gonzalez, MD
Départment of Gastroenterology
AP-HM, Aix-Marseille Université
Hôpital Nord
Marseille
France
Fax: +33-4-91968737   

Publikationsverlauf

Publikationsdatum:
14. November 2017 (online)

 

The esophagogastric junction (EGJ) is a rare location for gastrointestinal stromal tumors (GIST) and resection remains challenging in posterior/fundic lesions [1]. Laparoscopic and endoscopic cooperative surgery (LECS) is a new combined minimally invasive method [2] [3] [4]. Recently, a large series of 126 patients who underwent LECS for gastric submucosal tumors (86 GISTs) was published showing a high rate of feasibility and less than 5 % morbidity [5]. We report our experience in difficult gastric GIST resections.

Three patients underwent the procedure for posterior EGJ GISTs with various symptomatology. The absence of metastasis and the location of the GIST were confirmed by esophagogastroscopy and computed tomography scan ([Fig. 1]). All procedures were performed under general anesthesia and with orotracheal intubation. The LECS steps were ([Fig. 2], ([Video 1]): 1) exposing the esophagus and liberating the angle of His by laparoscopy; 2) full-thickness incision around the tumor by endoscopy (Hook knife; Olympus, Tokyo, Japan); 3) exposure of the tumor pedicle to the surgeon (forceps); 4) laparoscopic resection with linear stapler; 5) gastrotomy suturing.

Zoom Image
Fig. 1 Radiological and endoscopic view of a fundic gastrointestinal stromal tumor. a Computed tomography scan showing a stromal esophagogastric junction tumor of 5.2 cm. b Endoscopic retrograde view of the intraluminal part of the tumor.
Zoom Image
Fig. 2 Steps of laparoscopic and endoscopic cooperative surgical technique for esophagogastric junction (EGJ) gastrointestinal stromal tumor resection. a Tumor location. b Endoscopic intraluminal resection using monopolar electrocoagulation and retrograde view. c Laparoscopic intraperitoneal final resection of the tumor using a linear stapler. d Gastrotomy laparoscopic interrupted suture ends the procedure.

Video 1 Endoscopic intraluminal dissection of the tumor using carbohydrate gas. Transmural dissection of all layers of the stomach around the tumor was progressively and carefully performed using a diathermic electrosurgical knife. Laparoscopic resection of the tumor using a linear stapler. Tumor could then be removed in a bag and extracted by one of the port orifices.


Qualität:

All LECS procedures were performed successfully in a mean time of 107 minutes (range 90 – 120 minutes). The blood loss was very low and did not require any blood transfusion. There were no immediate perioperative complications such as spleen wound, pneumothorax, vagus nerve injury, or any other adverse event. The mean tumor size was 5.3 cm, with the largest diameter measuring 5.5 cm, 4.5 cm, and 6 cm, respectively, and with Miettinen grade considered as low or very low risk of recurrence. The mean fasting duration, including nasogastric tube time, was 5 days (range 2 – 8 days), and the median hospital stay was 9.3 days (range 5 – 14 days). No rehospitalization or latest complications were reported during a mean follow-up of 14 months. There was no recurrence of the tumors.

LECS following a rigorous surgical protocol is safe, and offers easiest accessibility and lower morbidity for complicated gastric GIST resection.

Endoscopy_UCTN_Code_TTT_1AT_2AD

Endoscopy E-Videos
https://eref.thieme.de/e-videos

Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online.
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos


#

Competing interests

Professor Barthet is a consultant for Boston Scientific.

  • References

  • 1 Blay J-Y, Bonvalot S, Casali P. et al. GIST consensus meeting panellists. 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
  • 2 Chen K, Zhou Y-C, Mou Y-P. et al. Systematic review and meta-analysis of safety and efficacy of laparoscopic resection for gastrointestinal stromal tumors of the stomach. Surg Endosc 2015; 29: 355-367
  • 3 Hiki N, Yamamoto Y, Fukunaga T. et al. Laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor dissection. Surg Endosc 2008; 22: 1729-1735
  • 4 Ntourakis D, Mavrogenis G. Cooperative laparoscopic endoscopic and hybrid laparoscopic surgery for upper gastrointestinal tumors: current status. World J Gastroenterol 2015; 21: 12482-12497
  • 5 Matsuda T, Nunobe S, Kosuga T. et al. Society for the Study of Laparoscopy and Endoscopy Cooperative Surgery. 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

Corresponding author

Jean-Michel Gonzalez, MD
Départment of Gastroenterology
AP-HM, Aix-Marseille Université
Hôpital Nord
Marseille
France
Fax: +33-4-91968737   

  • References

  • 1 Blay J-Y, Bonvalot S, Casali P. et al. GIST consensus meeting panellists. 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
  • 2 Chen K, Zhou Y-C, Mou Y-P. et al. Systematic review and meta-analysis of safety and efficacy of laparoscopic resection for gastrointestinal stromal tumors of the stomach. Surg Endosc 2015; 29: 355-367
  • 3 Hiki N, Yamamoto Y, Fukunaga T. et al. Laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor dissection. Surg Endosc 2008; 22: 1729-1735
  • 4 Ntourakis D, Mavrogenis G. Cooperative laparoscopic endoscopic and hybrid laparoscopic surgery for upper gastrointestinal tumors: current status. World J Gastroenterol 2015; 21: 12482-12497
  • 5 Matsuda T, Nunobe S, Kosuga T. et al. Society for the Study of Laparoscopy and Endoscopy Cooperative Surgery. 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

Zoom Image
Fig. 1 Radiological and endoscopic view of a fundic gastrointestinal stromal tumor. a Computed tomography scan showing a stromal esophagogastric junction tumor of 5.2 cm. b Endoscopic retrograde view of the intraluminal part of the tumor.
Zoom Image
Fig. 2 Steps of laparoscopic and endoscopic cooperative surgical technique for esophagogastric junction (EGJ) gastrointestinal stromal tumor resection. a Tumor location. b Endoscopic intraluminal resection using monopolar electrocoagulation and retrograde view. c Laparoscopic intraperitoneal final resection of the tumor using a linear stapler. d Gastrotomy laparoscopic interrupted suture ends the procedure.