A gasless laparoscopic technique of wide excision for gastric gastrointestinal stromal tumor versus open method
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WORLD JOURNAL OF SURGICAL ONCOLOGY
RESEARCH
Open Access
A gasless laparoscopic technique of wide excision for gastric gastrointestinal stromal tumor versus open method Po-Chu Lee1,2, Peng-Sheng Lai3, Ching-Yao Yang1, Chiung-Nien Chen1, I-Rue Lai1 and Ming-Tsan Lin1*
Abstract Background: Traditional open surgery for gastrointestinal stromal tumors (GIST) requires a long incision. Moreover, the gas-filling laparoscopic technique used in GIST surgery still has its limitations. Therefore, we developed a gasless laparoscopic (GL) surgery for GIST and compared it with traditional open surgery. Methods: Between October 2007 and September 2009, 62 GIST patients in the National Taiwan University Hospital received wide excisions. Of these 62 patients, 30 underwent the new procedure (GL group) and 32 had open surgery (OS group). Preoperative and postoperative clinicopathologic characteristics were compared between the groups. Results: There were no significant differences in preoperative characteristics or blood loss. However, the days to first flatus, postoperative hospital stay, wound length, white blood cell count at postoperative day one, and peak daily body temperature were all significantly improved in the GL group. Usage of postoperative analgesia on postoperative days one to five was also significantly lower in the GL group. Conclusions: Wide-excision laparoscopy for gastric GIST can be performed more safely, more effectively, and with faster postoperative recovery using the gasless technique as compared with the open method. We, therefore, recommend this new surgical technique, which hybridizes the advantages of both the traditional open method and pure laparoscopic surgery. Keywords: Gastrointestinal stromal tumors, Laparoscopic surgery, Surgical instruments
Background Surgical resection is the standard treatment for gastrointestinal stromal tumors (GIST), but the surgical methods require improvement. GIST, the most common mesenchymal tumor of the gastrointestinal tract, are divided into benign, intermediate, malignant, and those with malignant potential [1-4]. Lymph node dissection for malignant stromal tumor is optional. Among GIST patients, no difference in survival between systemic lymph node dissection and non-dissection groups was observed [5]. Wide excision for small malignant gastric stromal tumors without lymph node dissection is thought to be an acceptable treatment protocol [6-10]. * Correspondence: [email protected] 1 Department of General Surgery, National Taiwan University Hospital, No.7 Chung-Shan South Road, Taipei 100, Taiwan Full list of author information is available at the end of the article
Therefore, minimal access is potentially applicable and beneficial for GIST surgery. A traditional laparotomy may require a larger wound and a longer postoperative recovery period, whereas laparoscopic surgery may have advantages over open surgery that include early recovery of bowel function, early hospital discharge, and decreased pain [11,12]. However, there are still difficulties and risks relat
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