1. 蘇炳睿/ 趙盈瑞/沈延盛 國立成功大學醫學院附設醫院 一般外科
Laparoscopic Transgastric Excision of Gastric Submucosal Tumor Near Esophagogastric Junction
蘇炳睿/ 趙盈瑞/沈延盛
國立成功大學醫學院附設醫院 一般外科

2. Introduction Gastric submucosal tumors (SMTs)
Less than 2 % of all gastric neoplasms
Rare findings during routine PES
Wide spectrum, ranging from benign to highly malignant
Surgical resection is first choice of treatment
Difficulties and limitations of definitive preoperative dx
Local resection with a disease-free margin recommended
Lymphadenectomy not generally required

3. Laparoscopic resection
To preserve good gastric function
Tumors near esophagogastric junction(EGJ) with intraluminal growth, esp in posterior wall of cardia or large tumor
Laparoscopic wedge resection  deformity or stenosis
More sophisticated, tailored approach
To avoid a total or proximal gastrectomy
We introduce laparoscopic transgastric technique for gastric SMT near the EGJ

4. Intragastric Port

5. Surgical Technique Trocar insertion Localization of tumor
Intra-abdominalintra-gastric(balloon trocar)
Localization of tumor
NG through cardia orifice
Excision of tumor with free margin
Submucosal dissection with harmonic scalpel
Closure of defect
Precaution of stenosis of EGJ
Closure of gastrostomy

6. Data Collection 2010/9~2016/12, total 17 consecutive cases
2016:4 cases, 2015:4 cases, 2014:4 cases, 2013:3 cases
Pre-op evaluation : PES and CT
Retrospectively reviewed data
Pt demographics, dx workup, op findings, post-op course, morbidity and mortality, pathologic findings and f/u

7. Results 3 males, 14 females Mean age: 54 y/o (range: 27–83yrs)
Mean BMI: 24.1
Distance to EGJ: 12 cases less than 2 cm
Tumor size: mean (median, range)
2.25cm (2, 0.7~6.0 cm)
Pathology: 7 GISTs, 10 Leiomyomas

8. Results OP time, mean (median, range) 123.6 mins (118, 65~330 mins)
Only one case conversion to open procedure due to bleeding and flaccid gastric mucosa (first case)
Mean diet intake day: 2.3 days
Mean hospital stay: 6.7 days
Surgical complication (-)
Recurrence (-)

9. Discussion Surgical resection recommended for all gastric SMT
Malignant potential of GIST
GIST, <2 cm, could be cured by surgical resection
Laparoscopic surgery widespread acceptance for removal of gastric SMTs
Various laparoscopic approaches
Tumor’s characteristics, such as location, size, and growth pattern
Extragastric stapled wedge resection: most popular technique of good gastric function preservation

10. Discussion For tumors near EGJ early resection!! Near EGJ tumors
OP complication: high possibility of stenosis or deformity
Laparoscopic total, or proximal gastrectomy proposed
Too invasive !!! 80 % of them benign
Transgastric resection
Direct visualization of lesion and inner stomach
Better control of surgical margin
Avoid direct manipulation

11. Value of our Results
Transgastric resection : only few small single center series, most <10 EGJ tumors
Large series: mixed different laparoscopic techniques
Most studies focused on technique, lacked post-op recovery or pathology results.
Our report
Single standardized LTGR technique
Intragastric submucosal dissection and matured intragastric suture
Present both postoperative and pathology results

12. Conclusion Laparoscopic transgastric approach for SMT at EGJ
Safe and feasible
Meet oncological principles, even GIST
Experienced surgeons with advanced laparoscopic skills needed

13. Thanks for your listening!

14. Patient Demographics