Journal Article Laparoscopic and Open Resection of Gastrointestinal Stromal Tumors of the Stomach

Nakanishi, Ryota  ,  Takahashi, Ikuo  ,  Kajiwara, Yuichiro  ,  Motomura, Takashi  ,  Fujinaka, Yoshihiko  ,  Maehara, Shin-ichiro  ,  Maehara, Shinichiro  ,  Honbo, Takuya  ,  Soejima, Yuji  ,  Nishizaki, Takashi

106 ( 8 )  , pp.240 - 246 , 2015-08-25 , 福岡医学会
Introduction : Laparoscopic resection has been reported as reasonable for patients with gastrointestinal stromal tumors (GISTs). In this study, we report the feasibility of the laparoscopic approach for GIST of the stomach. We also discuss the laparoscopic approach for GIST larger than 5cm, which is reported to be difficult to treat by laparoscopic surgery. Materials and Methods : We retrospectively reviewed 22patients with GIST of the stomach resected by laparoscopic or open procedures between January 2006 and February 2014. Results : Laparoscopic resections were performed in 9patients and open resections in 13patients. Curative resections with negative resection margins were successfully completed for all patients. Although the size of the tumors was greater in open surgery cases than in laparoscopic patients (P=0.03), the loss of blood was lower and the hospital stay was shorter in laparoscopic cases (P=0.01 and 0.003, respectively). Laparoscopic resection was performed for 2patients with GISTs larger than 5cm. Both were located at greater curvature, and curatively resected without any complications or recurrence. Discussion : Our experience suggests that laparoscopic surgery for GISTs of the stomach, including those larger than 5cm, may be feasible after careful deliberation of its indications. Laparoscopic resection for GIST was associated with lower loss of blood and shorter hospital stay in comparison with open resection.
目的 : 消化管間葉系腫瘍(GIST)に対する腹腔鏡下切除術は,症例を限定すれば有用な手法であると報告されている.我々は胃のGISTに対する腹腔鏡下胃切除術の有用性について検証し,さらに腹腔鏡下手術が困難とされている5cm以上の胃GISTに対する腹腔鏡下手術の有用性についても考察した. 方法 : 2006年1月から2014年2月までに腹腔鏡下または開腹による胃切除術を受けた,胃GISTの22症例について後ろ向きに検討した. 結果 : 9症例は腹腔鏡下胃切除術を施行されており,13症例は開腹手術を受けていた.すべての症例で断端陰性であり,治癒切除が施行されていた.腹腔鏡下手術症例では開腹症例と比較して有意に腫瘍径が小さかったが(P=0.03),出血量は少なく(P=0.01),術後在院期間も短かった(P=0.003).胃大弯側に存在する5 cm以上の胃GISTの2症例に対しても腹腔鏡下手術が施行されていたが,いずれの症例も治癒切除が施行されており,術後合併症や再発は認めなかった. 考察 : 胃GIST症例に対する腹腔鏡下手術は有用であると考えられた.腫瘍径が5cm以上の胃GISTに対しても,腫瘍の位置や周囲組織との位置関係を考慮し慎重に適応を考慮することで,腹腔鏡下手術は有用と考えられた.胃GIST症例に対する腹腔鏡下手術は開腹手術と比較して手術時間が短く,在院日数も短縮していた.

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