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Hybrid push-pull endoscopic and laparoscopic full thickness resection for the minimally invasive management of gastrointestinal stromal tumors: a pilot clinical study.

Willingham FF, Reynolds P, Lewis M, Ross A, Maithel SK, Rocha FG - Gastroenterol Res Pract (2015)

Bottom Line: Methods.Conclusion.Endoscopic resection alone was associated with a positive deep margin, which the push-pull technique manages with a laparoscopic, full thickness, R0 resection.

View Article: PubMed Central - PubMed

Affiliation: Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA.

ABSTRACT
Background. Gastric gastrointestinal stromal tumors (GISTs) that are predominantly endophytic or in anatomically complex locations pose a challenge for laparoscopic wedge resection; however, endoscopic resection can be associated with a positive deep margin given the fourth-layer origin of the tumors. Methods. Patients at two tertiary care academic medical centers with gastric GISTs in difficult anatomic locations or with a predominant endophytic component were considered for enrollment. Preoperative esophagogastroduodenoscopy (EGD), endoscopic ultrasound (EUS) with or without fine needle aspiration (FNA), and cross-sectional imaging were performed. Eligible patients were offered and consented for hybrid and standard management. Results. Over ten months, four patients in two institutions with anatomically complex or endophytic GISTs underwent successful, uncomplicated push-pull hybrid procedures. GIST was confirmed in all resection specimens. Conclusion. In a highly selected population, the hybrid push-pull approach was safe and effective in the removal of complex gastric GISTs. Endoscopic resection alone was associated with a positive deep margin, which the push-pull technique manages with a laparoscopic, full thickness, R0 resection. This novel, minimally invasive, hybrid laparoscopic and endoscopic push-pull technique is a safe and feasible alternative in the management of select GISTs that are not amenable to standard laparoscopic resection.

No MeSH data available.


Related in: MedlinePlus

Patient 3's endoscopic specimen (a) shows spindle cells representative of GIST involving the submucosa and margin of the sample. The laparoscopic specimen (b) from the same patient demonstrates GIST cells confined superficial to the serosal surface. Patient 4's endoscopic specimen (c) likewise shows spindle cell involvement at the specimen's margin, while the laparoscopic specimen (d) exhibits a negative oncologic margin.
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fig3: Patient 3's endoscopic specimen (a) shows spindle cells representative of GIST involving the submucosa and margin of the sample. The laparoscopic specimen (b) from the same patient demonstrates GIST cells confined superficial to the serosal surface. Patient 4's endoscopic specimen (c) likewise shows spindle cell involvement at the specimen's margin, while the laparoscopic specimen (d) exhibits a negative oncologic margin.

Mentions: The third patient was found to have a suspicious lesion on imaging performed for dyspepsia, and subsequent EUS revealed a submucosal mass measuring 1.7 × 1.1 cm. Hybrid resection was considered due to the endophytic nature of the tumor and the poor visualization was expected with laparoscopy alone. Hybrid resection was successful, and pathology demonstrated a 2.6 × 1.9 cm mass with mitotic rate of 2 mitoses/50 hpf arising from the serosal layer (Figure 3(a)). The partial full thickness gastrectomy specimen demonstrated residual GIST in the resection site (Figure 3(b)). The final specimen had negative margins.


Hybrid push-pull endoscopic and laparoscopic full thickness resection for the minimally invasive management of gastrointestinal stromal tumors: a pilot clinical study.

Willingham FF, Reynolds P, Lewis M, Ross A, Maithel SK, Rocha FG - Gastroenterol Res Pract (2015)

Patient 3's endoscopic specimen (a) shows spindle cells representative of GIST involving the submucosa and margin of the sample. The laparoscopic specimen (b) from the same patient demonstrates GIST cells confined superficial to the serosal surface. Patient 4's endoscopic specimen (c) likewise shows spindle cell involvement at the specimen's margin, while the laparoscopic specimen (d) exhibits a negative oncologic margin.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4402559&req=5

fig3: Patient 3's endoscopic specimen (a) shows spindle cells representative of GIST involving the submucosa and margin of the sample. The laparoscopic specimen (b) from the same patient demonstrates GIST cells confined superficial to the serosal surface. Patient 4's endoscopic specimen (c) likewise shows spindle cell involvement at the specimen's margin, while the laparoscopic specimen (d) exhibits a negative oncologic margin.
Mentions: The third patient was found to have a suspicious lesion on imaging performed for dyspepsia, and subsequent EUS revealed a submucosal mass measuring 1.7 × 1.1 cm. Hybrid resection was considered due to the endophytic nature of the tumor and the poor visualization was expected with laparoscopy alone. Hybrid resection was successful, and pathology demonstrated a 2.6 × 1.9 cm mass with mitotic rate of 2 mitoses/50 hpf arising from the serosal layer (Figure 3(a)). The partial full thickness gastrectomy specimen demonstrated residual GIST in the resection site (Figure 3(b)). The final specimen had negative margins.

Bottom Line: Methods.Conclusion.Endoscopic resection alone was associated with a positive deep margin, which the push-pull technique manages with a laparoscopic, full thickness, R0 resection.

View Article: PubMed Central - PubMed

Affiliation: Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA.

ABSTRACT
Background. Gastric gastrointestinal stromal tumors (GISTs) that are predominantly endophytic or in anatomically complex locations pose a challenge for laparoscopic wedge resection; however, endoscopic resection can be associated with a positive deep margin given the fourth-layer origin of the tumors. Methods. Patients at two tertiary care academic medical centers with gastric GISTs in difficult anatomic locations or with a predominant endophytic component were considered for enrollment. Preoperative esophagogastroduodenoscopy (EGD), endoscopic ultrasound (EUS) with or without fine needle aspiration (FNA), and cross-sectional imaging were performed. Eligible patients were offered and consented for hybrid and standard management. Results. Over ten months, four patients in two institutions with anatomically complex or endophytic GISTs underwent successful, uncomplicated push-pull hybrid procedures. GIST was confirmed in all resection specimens. Conclusion. In a highly selected population, the hybrid push-pull approach was safe and effective in the removal of complex gastric GISTs. Endoscopic resection alone was associated with a positive deep margin, which the push-pull technique manages with a laparoscopic, full thickness, R0 resection. This novel, minimally invasive, hybrid laparoscopic and endoscopic push-pull technique is a safe and feasible alternative in the management of select GISTs that are not amenable to standard laparoscopic resection.

No MeSH data available.


Related in: MedlinePlus