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Laparoscopic wedge resection of gastric lesions: perioperative morbidity and long-term efficacy
Yuri W Novitsky1,2, George Poultsides1, Sarah Treter1, Kent W Kercher2, B. Todd Heniford2
1University of Connecticut Health Center, Farmington, CT;2Carolinas Medical Center, Charlotte, NC
Objective: Many submucosal gastric lesions are amenable to local resections. The feasibility of the minimally-invasive approach to those lesions has already been established. We hypothesized that complete wedge resection of various gastric tumors via a combination of laparoscopic or laparo-endoscopic techniques results in low perioperative morbidity and effective long-term control of the disease.
Design: Retrospective review
Setting: Tertiary-care hospitals
Patients: Consecutive cohort
Interventions: Laparoscopic wedge gastrectomy
Main Outcome Measures: patient demographics, operative findings, operative time and blood loss, complications, length of hospitalization, and tumor histopathology and recurrence rate.
Results: Between August 1996 and January 2006, 72 consecutive patients with mean age of 58 years underwent 61 laparoscopic, 6 laparo-endoscopic, and 5 hand-assisted local gastric resections. Forty-five (62%) lesions were discovered incidentally. Lesion location included GE-junction(8), cardia(11), body(27, including 8 posteriorly), lesser curve(8), and antrum/pyloric channel(14). Mean tumor size was 4.1cm (0.5-8.5). Mean operative time was 131 min (49-185), mean blood loss was 80 cc (10-350), and mean length of hospitalization was 3.8 days (1-10). All lesions had negative resection margins. Pathologic diagnosis included stromal tumor(56), carcinoid(5), pancreatic rest(4), adenoma(4), MALT(1), mucocele(1), and in-situ carcinoma(1). There were no perioperative complications or mortalities. No local or port site recurrences have been identified at a mean follow up of 25 months.
Conclusions: Laparoscopic local resections of various gastric pathologies in this series were associated with no significant complications, short hospitalizations, and no locoregional recurrences. Given the low morbidity and high efficacy of laparoscopic wedge resections, this approach may be preferred in management of the majority of patients with both incidental and symptomatic gastric tumors.
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