Laparoscopic-endoscopic rendezvous resection of gastric tumors

Background: Submucosal and mucosal tumors of the stomach display a wide spectrum of histopathologic and prognostic characteristics. Biopsies obtained using endoscopic techniques often do not provide the representative histologic sample needed for further therapeutic decisions. Methods: From 1999 to 2002, 18 patients with gastric tumors underwent a combined endoscopic-laparoscopic local resection of the tumors using two different procedures and were prospectively analyzed. Tumors of the posterior wall were resected using laparoscopic intragastral resection (LIR). Tumors located in the anterior wall were resected using lesion-lifting or the laparoscopic wedge resection (LWR) approach. Results: aparoscopic resections were performed in 18 patients. The mean age of the patients was 64.4 years (range, 38-81 years). Preoperative preparation included endoscopy with biopsies and histologic examination, ultrasound examination, computed tomography scan, and endoscopic ultrasonography. We performed the LWR on 10 patients and the LIR on 8 patients. After resection, the final immunohistologic examination of the specimens showed gastrointestinal stroma cell tumors in nine cases, neurinomas or benign neurofibrotic tumors in four cases, and one leiomyoma. Four additional patients with mucosal early gastric cancer and high comorbidity risks also underwent a limited full-thickness wedge resection. In all the patients, the surgical margins were tumor free, and no lymphatic or venous invasion was encountered in pathologic specimens. Method-specific complications occurred in one case (perforation of the stomach wall). No fatal outcome had to be registered. Conclusions: When selected properly, the laparoscopic-endoscopic approach is considered to be curative and minimally invasive for resection of localized gastric tumors. In cases of histopathologically unknown tumors preoperatively, definitive examination of the complete specimen provides the basis for further therapeutic decisions.