Background: Laparoscopic management of gastrointestinal stromal tumors (GISTs) is safe and effective. It is considered to be the preferred technique offered to the patient. Laparoscopic wedge resection has been widely accepted for small- and medium-sized GISTs. The use of laparoscopic approach should be based on a variety of factors including: patient characteristics, tumor size, and presence of invasion, location of tumor, surgeon and laparoscopic expertise.
Patients and methods: Total number of nine patients with GISTs who presented to our unit from January 2010 till May 2015 were retrospectively reviewed. Patients' demographics, clinical data, intraoperative and postoperative complications, and histopathological data were analyzed. Most lesions were resected via a wedge technique with closure of defect either by an endoscopic linear stapling device or intracorporeal suturing technique.
Results: Nine patients who presented with GISTs underwent laparoscopic resection according to its position and size. The median age at diagnosis was 48 years old, and average tumor size was 4.2 cm with the largest tumor measuring 7.5 cm. There was no episode of tumor rupture or spillage and no major intraoperative or postoperative complications. All margins were negative, mean follow up was 14.4 (range 8.5–15.2) months. Majority of lesions were resected via laparoscopic wedge resection except one case (female patient aged 48 years old) that presented with GIST located at the gastric fundus , this patient underwent proximal (partial gastrectomy) and another case (adult male 26 years old) that presented with upper rectal GIST was managed via laparoscopic anterior resection. There was no evidence of metastasis or recurrence except in the patient who had been presented with rectal GIST.
Conclusion: Laparoscopic resection is safe and effective for GISTs not exceeding 6 cm. Gastroesophageal junction and cardia GISTs require careful preoperative evaluation and planning to be removed safely. Laparoscopic removal is currently the surgical treatment of choice for patients with primary localized GISTs, and open surgery is not even considered unless there are contraindications to the laparoscopic approach