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Fan X, Cai X, Jiao J, Luo L, Maihemuti A, Wang T, Chen X, Zheng Z, Liu W. Efficacy analysis of modified double band ligation-assisted endoscopic submucosal resection and endoscopic mucosal dissection in the treatment of gastric gastrointestinal stromal tumors (≤ 1.5 cm). Surg Endosc 2025; 39:2471-2480. [PMID: 39994050 DOI: 10.1007/s00464-025-11598-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Accepted: 01/29/2025] [Indexed: 02/26/2025]
Abstract
BACKGROUND Recently, the application of double band ligation-assisted endoscopic submucosal resection (ESMR-DL) in the resection of rectal endocrine tumors ≤ 10 mm has shown promising prospects. However, the use of ESMR-DL has not been reported for gastric gastrointestinal stromal tumors (gGISTs). In this study, we aimed to compare the application of modified ESMR-DL with ESD in gGISTs (≤ 1.5 cm). METHODS Data were retrospectively collected from 472 patients who underwent modified ESMR-DL or endoscopic submucosal dissection (ESD) for resection of gGISTs (≤ 1.5 cm). To overcome selection bias, a propensity score matching method was applied using four covariates for 1:1 matching: sex, age, tumor size, and tumor location. Clinical data, surgical status, and postoperative outcomes were compared between the two groups. RESULTS Of the 472 patients, 78 (16.5%) received modified ESMR-DL and 394 (83.5%) received ESD; after matching, there were 78 patients in each group. There was no statistical difference in the baseline characteristics between the two groups after matching (p > 0.05). Compared to ESD, modified ESMR-DL resulted in shorter operation time, time to a liquid diet and postoperative hospitalization time, but had a higher incidence of intraoperative perforation (p < 0.05). There was no significant difference in the R0 resection rate of tumors, incidence of postoperative complications, and average hospitalization costs between the two groups after matching (p > 0.05). Univariate and multivariate analyses showed that the maximum dimension of the lesion (7 mm increments) and the surgical method were factors affecting procedure time, and the maximum dimension of the lesion (7 mm increments) and operator (novice vs instructor) were factors affecting intraoperative perforation in modified ESMR-DL (P < 0.05). During the follow-up, there were no recurrences or metastases of gGISTs in either group. CONCLUSIONS Modified ESMR-DL is noninferior to ESD with a similar complete resection rate. In addition, modified ESMR-DL had shorter procedure time and hospitalization time.
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Affiliation(s)
- Xiaofei Fan
- Department of Gastroenterology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, China
| | - Xiaohan Cai
- Department of Gastroenterology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, China
| | - Jiao Jiao
- Department of Gastroenterology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lili Luo
- Department of Geriatric, Tianjin Medical University General Hospital, Tianjin, China
| | - Ayixie Maihemuti
- Department of Gastroenterology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, China
| | - Tao Wang
- Department of Gastroenterology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, China
| | - Xin Chen
- Department of Gastroenterology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, China
| | - Zhongqing Zheng
- Department of Gastroenterology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, China
| | - Wentian Liu
- Department of Gastroenterology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, China.
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Lee WY. Laparoscopic wedge resection of a descending duodenal gastrointestinal stromal tumor under endoscopic nasobiliary drainage guidance: A case report. Int J Surg Case Rep 2025; 127:110877. [PMID: 39813985 PMCID: PMC11783127 DOI: 10.1016/j.ijscr.2025.110877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Revised: 01/08/2025] [Accepted: 01/11/2025] [Indexed: 01/18/2025] Open
Abstract
INTRODUCTION Gastrointestinal stromal tumors (GIST), which occur anywhere in the gastrointestinal (GI) tract, typically occur in the stomach and small intestine but rarely in the duodenum. We present a case report wherein a descending duodenal GIST was treated with a limited, minimally invasive surgery after endoscopic nasobiliary drainage (ENBD) insertion. PRESENTATION OF CASE A 67-year-old woman visited our hospital with an incidentally discovered duodenal tumor. Gastroduodenoscopy revealed a duodenal subepithelial tumor (SET) measuring approximately 2 cm in descending duodenum. Endoscopic ultrasound revealed a well-circumscribed, inhomogeneous hypoechoic lesion measuring approximately 17 × 4.6 mm, thought to arise from the muscularis layer. Computed tomography (CT) revealed an inhomogeneous enhancing mass with central necrosis, measuring approximately 2.7 cm, in the descending duodenum. Pathological findings from the bite-on-bite biopsy showed c-kit and DOG-1 positivity and CD34 and desmin negativity, leading to a GIST diagnosis. Laparoscopic wedge resection with preoperative ENBD insertion was planned due to the risk of pancreaticobiliary duct (PBD) damage during surgery because the lesion was located near the ampulla of Vater (AoV) and minor papilla. Surgery was performed using laparoscopic wedge resection without PBD injury. The patient was discharged 10 days post-surgery without complications. DISCUSSION Descending duodenal GIST is difficult to operate on with minimally invasive surgery. However, if the size is not excessive and the PBD is not involved, minimal and limited surgery is possible after ENBD insertion. CONCLUSION We report the first case of limited and minimally invasive surgery followed by ENBD insertion in a rare descending duodenal GIST.
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Affiliation(s)
- Woo Yong Lee
- Department of Surgery, Inje University Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea.
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Wu L, Liu M, Lin X, Wang C, Yang Y, Fang H, Huang H, Lin R, Lu F. Feasibility and efficacy of minimally invasive limited resection for primary duodenal gastrointestinal stromal tumors: a retrospective cohort study. BMC Surg 2024; 24:126. [PMID: 38678296 PMCID: PMC11055357 DOI: 10.1186/s12893-024-02417-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/17/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND The primary duodenal gastrointestinal stromal tumor (GIST) is a rare type of gastrointestinal tract tumor. Limited resection (LR) has been increasingly performed for duodenal GIST. However, only a few studies reported minimally invasive limited resection (MI-LR) for primary duodenal GIST. METHODS The clinical data of 33 patients with primary duodenal GIST from December 2014 to February 2024 were retrospectively analyzed including 23 who received MI-LR and 10 who received laparoscopic or robotic pancreaticoduodenectomy (LPD/RPD). RESULTS A total of 33 patients with primary duodenal GIST were enrolled and retrospectively reviewed. Patients received MI-LR exhibited less OT (280 vs. 388.5min, P=0.004), EBL (100 vs. 450ml, P<0.001), and lower morbidity of postoperative complications (52.2% vs. 100%, P=0.013) than LPD/RPD. Patients received LPD/RPD burdened more aggressive tumors with larger size (P=0.047), higher classification (P<0.001), and more mitotic count/50 HPF(P=0.005) compared with patients received MI-LR. The oncological outcomes were similar in MI-LR group and LPD/RPD group. All the patients underwent MI-LR with no conversion, including 12 cases of LLR and 11 cases of RLR. All of the clinicopathological data of the patients were similar in both groups. The median OT was 280(210-480) min and 257(180-450) min, and the median EBL was 100(20-1000) mL and 100(20-200) mL in the LLR and the RLR group separately. The postoperative complications mainly included DGE (LLR 4 cases, 33.4% and RLR 4 cases, 36.4%), intestinal fistula (LLR 2 cases, 16.7%, and RLR 0 case), gastrointestinal hemorrhage (LLR 0 case and RLR 1 case, 9.1%), and intra-abdominal infection (LLR 3 cases, 25.0% and RLR 1 case, 9.1%). The median postoperative length of hospitalization was 19.5(7-46) days in the LLR group and 19(9-38) days in the RLR group. No anastomotic stenosis, local recurrence or distant metastasis was observed during the follow-up period in the two groups. CONCLUSIONS Minimally invasive limited resection is an optional treatment for primary duodenal GIST with satisfactory short-term and long-term oncological outcomes.
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Affiliation(s)
- Longhang Wu
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Miao Liu
- Fujian Clinical Research Center for Digestive System Tumors and Upper Gastrointestinal Diseases, Fuzhou, Fujian, China
- Department of Gastrointestinal Endoscopy Nursing, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Xianchao Lin
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Congfei Wang
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Yuanyuan Yang
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Haizong Fang
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Heguang Huang
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Ronggui Lin
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
| | - Fengchun Lu
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
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Li TN, Liu YH, Zhao J, Mu H, Cao L. Treatment of hemolymphangioma by robotic surgery: A case report. World J Gastrointest Surg 2024; 16:596-600. [PMID: 38463376 PMCID: PMC10921197 DOI: 10.4240/wjgs.v16.i2.596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/10/2023] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Hemolymphangioma of the jejunum is rare and lacks clinical specificity, and can manifest as gastrointestinal bleeding, abdominal pain, and intestinal obstruction. Computed tomography, magnetic resonance imaging, and other examinations show certain characteristics of the disease, but lack accuracy. Although capsule endoscopy and enteroscopy make up for this deficiency, the diagnosis also still requires pathology. CASE SUMMARY A male patient was admitted to the hospital due to abdominal distension and abdominal pain, but a specific diagnosis by computed tomography examination was not obtained. Partial resection of the small intestine was performed by robotic surgery, and postoperative pathological biopsy confirmed the diagnosis of hemolymphangioma. No recurrence in the follow-up examination was observed. CONCLUSION Robotic surgery is an effective way to treat hemolymphangioma through minimally invasive techniques under the concept of rapid rehabilitation.
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Affiliation(s)
- Tian-Ning Li
- Department of Clinical Lab, Tianjin First Central Hospital, Tianjin 300000, China
| | - Yan-Hong Liu
- Nankai University, Tianjin Union Medical Center, Tianjin 300000, China
| | - Jia Zhao
- Nankai University, Tianjin Union Medical Center, Tianjin 300000, China
| | - Hong Mu
- Tianjin Medical University, Tianjin First Center Hospital, Tianjin 300000, China
| | - Lei Cao
- Nankai University, Tianjin Union Medical Center, Tianjin 300000, China
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Yue L, Sun Y, Wang X, Hu W. Advances of endoscopic and surgical management in gastrointestinal stromal tumors. Front Surg 2023; 10:1092997. [PMID: 37123546 PMCID: PMC10130460 DOI: 10.3389/fsurg.2023.1092997] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/24/2023] [Indexed: 05/02/2023] Open
Abstract
As one of the most common mesenchymal malignancies in the digestive system, gastrointestinal stromal tumors (GISTs) occur throughout the alimentary tract with diversified oncological characteristics. With the advent of the tyrosine kinase inhibitor era, the treatment regimens of patients with GISTs have been revolutionized and GISTs have become the paradigm of multidisciplinary therapy. However, surgery resection remains recognized as the potentially curative management for the radical resection and provided with favorable oncological outcomes. The existing available surgery algorithms in clinical practice primarily incorporate open procedure, and endoscopic and laparoscopic surgery together with combined operation techniques. The performance of various surgery methods often refers to the consideration of risk evaluation of recurrence and metastases; the degree of disease progression; size, location, and growth pattern of tumor; general conditions of selected patients; and indications and safety profile of various techniques. In the present review, we summarize the fundamental principle of surgery of GISTs based on risk assessment as well as tumor size, location, and degree of progress with an emphasis on the indications, strengths, and limitations of current surgery techniques.
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Affiliation(s)
- Lei Yue
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, China
| | - Yingchao Sun
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, China
| | - Xinjie Wang
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, China
| | - Weiling Hu
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, China
- Institute of Gastroenterology, Zhejiang University (IGZJU), Hangzhou, China
- Zhejiang University Cancer Center, Hangzhou, China
- Correspondence: Weiling Hu
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