article = {JSO-2019-1-104}
title = {Laparoscopic Organ-Conserving and Function-Preserving Surgical Resectional Strategy for Gastric Gastro-Intestinal Stromal Tumours (GISTs) is Safe and Effective}
journal = {Journal of Surgical Oncology}
year = {2019}
issn = {2674-3000}
doi = {http://dx.doi.org/10.31487/j.JSO.2019.01.004}
url = {https://www.sciencerepository.org/laparoscopic-organ-conserving-and-function-preserving-surgical-resectional-strategy-for-gastric-gastro-intestinal-stromal-tumours-GISTs-is-safe-and-effective_SR-JSO-2019-1-104 
author = {Ashraf Rasheed,Catherine  Eley,}
keywords = {Gastro-intestinal stromal tumour, GIST, Stomach cancer, Laparoscopy}
abstract ={Background
Gastro-intestinal stromal tumours form the most clinically important and most common group of
submucosal tumours of the stomach. A gain-of-function mutation in genes coding for the KIT tyrosine
kinase receptor plays a pivotal role in the differentiation and proliferation of GISTs. Surgical resection offers
the only chance of cure however the consensus opinion from the European Society of Medical Oncology
(ESMO) restrict laparoscopic approaches to tumours <2cm in certain anatomical locations provided surgical
oncological principles are observed. This study will assess the safety, effectiveness, and functional outcomes
of an anatomically-based strategy for the laparoscopic resection of gastric GISTs.
Methods
All symptomatic gastric GISTs diagnosed during a 5 years period were considered for minimal access
surgical resection. Lesions were removed according to a structured anatomical approach. The strategy was
designed to conserve the organ and preserve sphincter (lower oesophageal and pyloric) function while
adhering to oncological principles. A prospective database included patients’ demographics, clinical
features, imaging, procedure type, operative findings, complications, histopathology,
immunohistochemistry, mutation status and risk stratification. Clinical and radiological follow-up was
recorded.
Results
Thirty-two (32) cases of suspected gastric GISTs were considered for minimal access resection during the
study. Twenty-three patients (72%) underwent a laparoscopic wedge resection, six patients (19%)
underwent an extra-gastric anterior resection and three patients (9%) underwent trans-gastric posterior
resection. 97% were histologically confirmed GIST, all achieving R0 excision. 97% were disease free at 20
months.
Conclusion
The authors have demonstrated that an anatomically-based surgical strategy for the laparoscopic resection
of gastric submucosal tumours is safe and enjoys an oncological and functional success. This, along with
the recognised reduced morbidity associated with minimal access surgery lend support to the notion that
laparoscopic surgery might be the preferable approach for small to medium sized gastric GISTs.}