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NESS 2006 Annual Meeting
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Endoscopically assisted Laparoscopic Resections of Submucosal Gastric and GE Junction Tumors- A Novel Approach to Resection Based on Tumor Location.
Laurence E McCahill1, Alicia Privette1, Rick Zubarik1, Nicole Messier2, Edward Borrazzo1
1University of Vermont, Burlington, VT;2Fletcher Allen Health Care, Burlington, VT

Objectives: To identify endoscopic features of submucosal gastric tumors that determine the appropriate laparoscopic approach for definitive tumor resection.
Design: Retrospective Observational Study
Setting: Tertiary Care, University-based Hospital
Patients: All consecutive patients with submucosal gastric tumors seen from Jan 2005 through March 2006.
Interventions: Patients underwent combined intra-operative Gastroscopy and laparoscopic resection of the tumors, utilizing picture-in picture technology. Transgastric resections were performed intraluminally.
Main Outcome Measures: Tumor features (size and location), which determined surgical approach, were identified. Operative procedures performed, blood loss, and duration of hospital stay.
Results: Ten patients (M:F 7:3) with a mean age of 60.9 years (range 33-92) were identified pre-operatively by endoscopy/EUS to have submucosal gastric tumors. Tumor location/Procedure performed:
GE jxn/high lesser curve: 3
Transgastric/Laparoscopic Partial Gastrectomy
Fundus/ Upper body: 4
Laparoscopic Partial Gastrectomy
Antrum/ Distal Body: 3
Laparoscopic Distal Gastrectomy
Estimated Blood Loss was minimal (range 50-200 cc), and mean hospital stay was 3.9 days (Transgastric 2 days, Lap PG 3.6 days, Lap DG 7.3 days). A small bowel enterotomy occurred in a patient with a prior colectomy.
Median tumor size was 4.5 cm (2.5-7.0) and did not appear to influence procedure performed. Pathologic diagnoses included 7 GISTs (all c-kit + and/or CD34 +) and 3 benign tumors. All surgical margins were negative. No patient has sustained any recurrence to date.
Conclusion: Submucosal gastric tumors may be safely resected laparoscopically utilizing Intraoperative gastroscopy, with tumor location the key component of determining the approach to tumor resection.

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