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Nicola S, Santolo DG, Luciana C. Laparoscopic partial gastrectomy for a giant bleeding GIST of the stomach: A case report. Int J Surg Case Rep 2022; 101:107759. [PMID: 36395658 PMCID: PMC9672951 DOI: 10.1016/j.ijscr.2022.107759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Gastrointestinal stromal tumors (GIST) are rare neoplasms often located in the stomach. Elective laparoscopic surgery is the well-established treatment. Often these tumors have a presentation with acute gastrointestinal bleeding and/or as large masses that challenge mini invasive laparoscopic approach. This article describes the case of a patient with large gastric GIST with bleeding onset and discusses the feasibility and safety of emergency laparoscopy. Presentation of case A 36-year-old man presented with melena and severe anaemia. An upper endoscopy and abdominal CT scan showed a large gastric fundal submucosal mass of more than 10 cm of diameter close to the superior splenic pole. Because of relapsing bleeding he was submitted to emergency laparoscopy with complete resection of the gastric mass by partial gastrectomy. Discussion Laparoscopic approach to GIST larger than 10 cm is still a challenging surgical task and the feasibility depends on multiple factors including the location and size of the lesions. Few series of patients have been described in the literature. This case described a giant GIST with major and relapsing gastrointestinal bleeding that induced an emergency surgically approach with a minimally invasive laparoscopic partial gastric resection. Conclusions This report described a case of giant gastric GIST that presented with repeated and severe gastrointestinal bleeding and was treated by emergency laparoscopic gastric resection. The feasibility and advantages of the surgical technique are discussed. The best surgical approach in these rare cases has still to be evaluated on individual basis. Laparoscopic surgical approach for giant gastric GIST is still challenging Emergency surgery for bleeding GIST has not been frequently described Laparoscopic surgical resection of giant gist is feasible but has to be evaluated on an individual basis
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Vicente E, Quijano Y, Ielpo B, Duran H, Diaz E, Fabra I, Malave L, Ferri V, Ferronetti A, Caruso R. Robot-assisted resection of gastrointestinal stromal tumors (GIST): a single center case series and literature review. Int J Med Robot 2015; 12:718-723. [PMID: 26549309 DOI: 10.1002/rcs.1712] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 07/15/2015] [Accepted: 10/05/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Robotic techniques are claimed to be an alternative to laparoscopic and open approaches for gastrointestinal stromal tumors (GIST) treatment. Our aim is to present our single center experience and a literature review. MATERIALS AND METHODS From June 2012 to August 2014, six patients with preoperative diagnosis of GIST were treated by robotic surgery at Sanchinarro University Hospital. RESULTS Two GIST tumors were localized in the second part of the duodenum, one in the first portion, two in the gastricantrum and another in the angular notch. Surgical procedures performed were two subtotal gastrectomies, one gastric wedge resection and three duodenal enucleations. None of the interventions needed conversion to open surgery. Mean operative time was 245 min (150-540). Mean hospital stay was 10.5 days (6-24). All lesions had microscopically negative resection margins. Mean follow-up was 24 months (8-33) with a disease-free survival rate of 100%. CONCLUSIONS A robotic approach for GIST tumors is a safe and feasible procedure with a well-accepted oncological surgical result. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Emilio Vicente
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Yolanda Quijano
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Benedetto Ielpo
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Hipolito Duran
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Eduardo Diaz
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Isabel Fabra
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Luis Malave
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Valentina Ferri
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Antonio Ferronetti
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Riccardo Caruso
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
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Abstract
A laparoscopic approach to gastrointestinal stromal tumors (GISTs) of the small bowel seems to be a safe method even in the face of emergent surgery when open oncologic principles of bowel and tumor handling are followed. Background: Gastrointestinal stromal (GIST) tumors make < 1% of all gastrointestinal neoplasms and 20% of small bowel neoplasms. The most common acute presenting symptom of these tumors is gastrointestinal hemorrhage with obstruction being rare. We discuss our laparoscopic approach to 2 patients with small bowel GIST tumors that presented to our institution with obstruction of the small bowel. Case Presentation: Two patients presented to the emergency department with signs and symptoms of small bowel obstruction. On workup, each was found to have a solid lesion either within or adjacent to the small bowel at the point of obstruction and both were emergently taken to the operating room. The pathologic diagnosis of small bowel GIST tumor was the same in both cases, but the pathophysiologies of the obstructing tumors were different. Results: Both patients underwent laparoscopic surgery with successful resection of the lesions. The details and crucial points of the laparoscopic approach to these tumors are described with specific attention to its appropriateness and safety in treating GIST tumors. Attention to particular details of the manipulation and management of the bowel in the face of obstruction and removal of the lesions is described. Conclusion: The laparoscopic approach to GIST tumors of the small bowel, even in the face of emergent surgery, is a safe method.
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Affiliation(s)
- John E Morrison
- Department of Surgery, LA State University Health Sciences Center, Earl K. Long Hospital, Baton Rouge, LA, USA
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Abstract
BACKGROUND Gastrointestinal stromal (GIST) tumors make <1% of all gastrointestinal neoplasms and 20% of small bowel neoplasms. The most common acute presenting symptom of these tumors is gastrointestinal hemorrhage with obstruction being rare. We discuss our laparoscopic approach to 2 patients with small bowel GIST tumors that presented to our institution with obstruction of the small bowel. CASE PRESENTATION Two patients presented to the emergency department with signs and symptoms of small bowel obstruction. On workup, each was found to have a solid lesion either within or adjacent to the small bowel at the point of obstruction and both were emergently taken to the operating room. The pathologic diagnosis of small bowel GIST tumor was the same in both cases, but the pathophysiologies of the obstructing tumors were different. RESULTS Both patients underwent laparoscopic surgery with successful resection of the lesions. The details and crucial points of the laparoscopic approach to these tumors are described with specific attention to its appropriateness and safety in treating GIST tumors. Attention to particular details of the manipulation and management of the bowel in the face of obstruction and removal of the lesions is described. CONCLUSION The laparoscopic approach to GIST tumors of the small bowel, even in the face of emergent surgery, is a safe method.
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Affiliation(s)
- John E Morrison
- Department of Surgery, LA State University Health Sciences Center, Earl K. Long Hospital, Baton Rouge, LA, USA
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Daly SC, Popoff AM, Fogg L, Francescatti AB, Myers JA, Millikan KW, Deziel DJ, Luu MB. Minimally invasive technique leads to decreased morbidity and mortality in small bowel resections compared to an open technique: an ACS-NSQIP identified target for improvement. J Gastrointest Surg 2014; 18:1171-5. [PMID: 24692089 DOI: 10.1007/s11605-014-2493-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 02/28/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND We hypothesize that currently minimally invasive techniques are underutilized, leading to unnecessary morbidity and mortality. The objective of the study was to compare morbidity and mortality rates in patients receiving a minimally invasive (MIS) small bowel resection to patients receiving an open (OP) small bowel resection. METHODS Patients in the National Surgical Quality Improvement Program (NSQIP) database who underwent a small bowel resection between 2007 and 2011 were enrolled in the study and grouped whether they received a MIS procedure (n = 1,780) or an OP procedure (n = 17,701). The primary endpoint of the study was to evaluate the difference in morbidity (excluding mortality) and mortality in patients undergoing a minimally invasive procedure compared to an open procedure. RESULTS The MIS technique is utilized in 9.0 % of patients undergoing a small bowel resection. Significantly lower mortality rate (2.9 vs. 8.2 %; p < 0.001) and mean morbidity rate (1.7 vs. 4.3 %; p < 0.001) were demonstrated in the MIS group. Significantly lower mean major morbidity rate (1.4 vs. 3.9 %; p < 0.001) and mean minor morbidity rate (2.6 vs. 5.5 %; p < 0.001) were demonstrated in the MIS group. CONCLUSION The MIS technique in small bowel resections appears to be underutilized, with only 9.0 % of patients in need of a small bowel resection undergo the minimally invasive approach. Wider utilization of the MIS technique could lead to significantly decreased morbidity and mortality.
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Affiliation(s)
- Shaun C Daly
- Department of General Surgery, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL, 60612, USA
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Bareck E, Ba-Ssalamah A, Brodowicz T, Eisterer W, Häfner M, Högenauer C, Kastner U, Kühr T, Längle F, Liegl-Atzwanger B, Schoppmann SF, Widmann G, Wrba F, Zacherl J, Ploner F. Gastrointestinal stromal tumors: diagnosis, therapy and follow-up care in Austria. Wien Med Wochenschr 2013; 163:137-52. [PMID: 23508516 DOI: 10.1007/s10354-013-0187-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 01/31/2013] [Indexed: 12/16/2022]
Abstract
Optimal treatment for patients suffering from gastrointestinal stromal tumors (GIST) is based on an interdisciplinary treatment approach. Austrian representatives of Medical and Surgical Oncology, Pathology, Radiology, Nuclear Medicine, Gastroenterology, and Laboratory Medicine issued this manuscript on a consensual base within the context of currently available and published literature. This paper contains guidelines and recommendations for diagnosis, therapy, and follow-up of GIST patients in Austria.
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Affiliation(s)
- Evelyne Bareck
- Department of Surgery, General Hospital, Wiener Neustadt, Vienna, Austria.
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Buchs NC, Bucher P, Pugin F, Hagen ME, Morel P. Robot-assisted oncologic resection for large gastric gastrointestinal stromal tumor: a preliminary case series. J Laparoendosc Adv Surg Tech A 2010; 20:411-5. [PMID: 20459328 DOI: 10.1089/lap.2009.0385] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Laparoscopic resection of gastric gastrointestinal stromal tumor (GIST) has been shown as feasible and safe in terms of oncologic results. However, laparoscopic resection has been demonstrated to be mainly suitable for small, favorably localized GIST. The robotic approach may, by its characteristics, enable the surgeon to perform atypical gastrectomies in an unfavorable location (i.e., close to pylorus or cardia). Its use in oncologic gastric surgery has been poorly defined and has never been reported for GIST. MATERIALS AND METHODS All patients who underwent robotic-assisted gastric resection for GIST at a single institution from 2006 to 2009 were prospectively followed-up. RESULTS There were 5 patients (3 men and 2 women), with a median age of 39 years (range, 32-74), who had a complete resection (R0). Two patients had a cardial GIST and 3 of the antrum. Median tumor sizes were of 5.5 cm (range, 4.2-7). According to Fletcher criteria, 4 tumors (80%) were classified as intermediate or high risk. No postoperative morbidity and mortality were noted. One patient had a conversion to open surgery because of a suspicion of diffuse adenocarcinoma on fresh frozen section and necessitated a total gastrectomy with a radical lymph node dissection. Median operation time was 192 minutes (range, 132-285). With a median follow-up of 18 months (range, 11-27), disease-free survival rate was 100%. CONCLUSIONS The da Vinci robot (Intuitive Surgical, Inc., Sunnyvale, CA) is a valuable instrument for oncologically safe resection with esogastric or duodenogastric junction preservation for an unfavorably located gastric GIST. Moreover, the three-dimensional, high-definition vision, instrument mobility, and ease of performing a difficult suturing enable a safe, large atypical gastrectomy, close to the pylorus or cardia.
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Affiliation(s)
- Nicolas C Buchs
- Department of Surgery, University Hospital Geneva, Geneva, Switzerland.
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Application of laparoscopy in the management of obscure gastrointestinal bleeding. Surg Laparosc Endosc Percutan Tech 2010; 20:89-92. [PMID: 20393334 DOI: 10.1097/sle.0b013e3181d84821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Gastrointestinal (GI) bleeding is considered obscure when it persists or recurs after negative endoscopy. Small bowel lesions account for approximately 1-fourth of cases of obscure GI bleeding. These lack specific clinical symtoms and signs, and tend to be inaccessible to routine examinations. The management of patients with intermittent obscure GI bleeding poses both diagnostic and therapeutic challenges. The aim of this study was to report the importance of laparoscopy in diagnosing and treating small bowel lesions responsible for obscure bleeding in 5 patients with subacute presentations. Data were collected from 2 hospitals' in-patient records and a prospective database. All patients underwent laparoscopic exploration. After the identification of the diseased segments, laparoscopy-assisted segmental resection of the small bowel and enteroentorostomy were carried out in all cases. This approach enabled a successful minimally invasive treatment of the obscure GI bleeding. The overall procedure was safe and our results were satisfactory.
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Ploner F, Zacherl J, Wrba F, Längle F, Bareck E, Eisterer W, Kühr T, Schima W, Häfner M, Brodowicz T. Gastrointestinal stromal tumors: Recommendations on diagnosis, therapy and follow-up care in Austria. Wien Klin Wochenschr 2010; 121:780-90. [PMID: 20047117 DOI: 10.1007/s00508-009-1278-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 11/11/2009] [Indexed: 12/21/2022]
Abstract
Adequate treatment of gastrointestinal stromal tumors (GISTs) is linked to an interdisciplinary treatment approach. Austrian representatives of medical oncology, surgery, pathology, radiology and gastroenterology have issued this consensus manuscript within the context of currently available and published literature. The paper contains guidelines and recommendations for diagnosis, therapy and follow-up of GIST patients in Austria.
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Affiliation(s)
- Ferdinand Ploner
- Clinical Division of Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria
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[Gastrointestinal stromal tumors: recommendations for diagnosis, treatment and aftercare in Austria]. Wien Med Wochenschr 2009; 159:370-82. [PMID: 19696980 DOI: 10.1007/s10354-009-0685-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 07/16/2009] [Indexed: 10/20/2022]
Abstract
Diagnosis and treatment of gastrointestinal stromal tumors (GIST) requires an interdisciplinary treatment approach. This strategy should be reflected by the content of this article. Austrian representatives of 'GIST relevant' specialties authored this publication on a consensual base. This manuscript should be regarded as a guideline for 'GIST involved' colleagues in Austria.
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