Laparoscopic Surgery for Submucosal Tumor Near the Esophagogastric Junction

Background: Laparoscopic surgery is widely accepted as a treatment for gastric submucosal tumors (SMTs). However, laparoscopy is not easily applied to tumors near the esophagogastric junction (EGJ). This study was conducted to evaluate laparoscopic techniques for treating SMTs near the EGJ. Subjects and Methods: Between March 2008 and August 2012 at the Asan Medical Center, Seoul, Korea, we performed laparoscopic surgery on 71 patients who had SMTs located within 3cm of the EGJ. The laparoscopic approach chosen depended on the position of the tumor, which was located accurately by preoperative diagnosis. Results: None of the patients required conversion to open surgery. Of the 71 patients in the study, 66 had laparoscopic wedge resection (LAPWR), 4 had laparoscopic enucleation, and 1 had laparoscopic proximal gastrectomy. Two patients had intraoperative events during LAPWR. One had EGJ stricture, which required laparoscopic esophagogastrostomy. The other had a muscle defect of the posterior wall of the distal esophagus, and the defect was covered using fundus-like fundoplication. All patients had tumor-free resection margins, and there were no deaths. Conclusions: Laparoscopic resection of SMTs near the EGJ may be performed safely. The laparoscopic approach used depends on the location and size of the tumor and on the extent of gastric resection.