Laparoscopic resection of small gastric submucosal tumors

No consensus exists regarding the necessity of operative resection for patients with small, asymptomatic gastric submucosal tumors (SMTs). The purpose of this study is to evaluate clinical outcomes of resection by minimally invasive surgery. The medical records of 20 consecutive patients who had undergone laparoscopic or robotic wedge resection for small (< 5 cm) gastric SMTs between March 2008 and February 2009 were reviewed. Operative indications included all SMTs unquestionably visible by endoscopy, irrespective of symptoms. The operative procedures, clinicopathologic features, and operative results were assessed. Out of a total of 20 patients, 17 were asymptomatic, and 3 presented with vague abdominal discomfort. One patient had two tumors, therefore 21 total lesions were resected and evaluated (19 by laparoscopy and 2 by robotic procedures). There were 12 exogastric and 9 transgastric wedge resections. Mean operative time was 84 +/- A 28 min, and mean length of hospitalization was 4.7 +/- A 1.6 days. There were no major peri- or postoperative complications or mortalities. Mean tumor size was 2.4 +/- A 1.2 cm (range 0.6-4.8 cm). All lesions had microscopically negative resection margins. There were 16 gastrointestinal tumors (GISTs) and 5 other benign lesions. Fifteen of the GISTs had mitotic count (MC) < 5 per 50 high-power fields (HPFs), and one lesion measuring 2.5 cm in size had MC of 38 per 50 HPFs. Small size cannot guarantee a specific malignant risk for gastric SMTs. Laparoscopic/robotic wedge resection is safe and effective in treating small, asymptomatic lesions. Therefore, an active surgical approach should be considered for management of patients with small gastric SMTs.