Should every laparoscopic wedge resection of gastric gastrointestinal stromal tumours be assisted by endoscopy?

INTRODUCTION: Gastrointestinal stromal tumours (GIST) are rare mesenchymal tumours of the gastrointesti-nal tract. Laparoscopic wedge resection is the first and most appropriate option. It is becoming increasingly common to use intraoperative endoscopy to ensure adequate surgical margins. In this study, we tried to make a suggestion by examining the clinical and operative features of gastric GIST patients in whom we performed endoscopy-assisted laparoscopic wedge resection.
METHODS: Patients underwent laparoscopic wedge resection for tumors located in various locations of the stomach with another surgeon providing endoscopic support. Age, gender, endoscopic and radiological localization of the tumor, tumor size, type of operation, duration of operation, amount of bleeding during operation were recorded from file data; and tumor cell type, size, surgical margin distance, number of mitosis, and GIST risk scores were recorded from pathology reports. We especially examined completeness of resection in pathology reports.
RESULTS: During the four-year study period, 22 patients underwent resection for gastric GIST. No complica-tions occurred during the surgery. The mean tumor size was 4.5 cm (2-7). We achieved complete resection in 100% of cases.
DISCUSSION AND CONCLUSION: Preserving the gastric tissue as much as possible and maintaining proper functions are achieved with wedge resections rather than formal gastrectomy. In this study, we tried to show that endoscopy is use-ful in wedge resections for these tumours regardless of localisation, not only at the junction or in difficult locations. We believe that endoscopic control before and after wedge resection for any localised tumour will reduce the number of complications and provide a safer operation, as well as having a positive effect on the surgical margin. We can say that endoscopic support is advantageous in confirming complete resection and absence of stenosis, deformation and leakage at the stapler line, and we recommend routine endoscopy support in these operations.

Keywords: Gatsrointestinal stromal tumors, laparoscopy, stomach