A narrative review of minimally invasive techniques for treatment of gastric gastrointestinal stromal tumors Article Swipe
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· 2022
· Open Access
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· DOI: https://doi.org/10.21037/gist-21-22
· OA: W4307878187
Background and Objective: Minimally invasive approach for small gastric gastrointestinal stromal tumors (GISTs) (<5 cm) is widely accepted according to National Comprehensive Cancer Network (NCCN) and European Society for Medical Oncology (ESMO) guidelines published in 2010. During last 15 years, many different techniques were proposed with the intent to reduce invasiveness ensuring adequate oncological radicality. In this chapter, we describe the laparoscopic, robotic and laparoscopic-endoscopic cooperative techniques for the treatment of this type of neoplasms. Our technique is also described. Methods: We have conducted a literature review from 01.01.2008 to 06.31.2021 on PubMed database for studies regarding laparoscopic, robotic and endoscopic techniques for treatment of gastric GISTs. The medical search headings (MeSH) “gastric GIST”, “laparoscopic GIST”, “robotic GIST”, “minimally invasive surgery”, “laparoscopic and endoscopic cooperative surgery procedures” and combinations of these were used. The lists of articles identified were examined to find relevant studies cited in this article. These studies compared sometimes different approaches (laparoscopic, robotic, laparoscopic and endoscopic cooperative surgery procedures), dividing the GISTs according to their gastric site and different types of resection. We analysed review, systematic review, and meta-analyses, restricting to English-language publications. Key Content and Findings: The choice of the best approach is related to GIST site (gastroesophageal junctional, fundus and body, antrum and pylorus) and configuration (exophytic or endophytic). The principal intent is to obtain margin-free (R0) resections avoiding the rupture of the lesion. For these, many tips and tricks to perform “no touch” technique and minimize the risk of dissemination and strategy to avoid post-operative complication are descripted. Conclusions: Minimally invasive surgery to resect GISTs is safe and oncologically effective. Techniques described should be part of the armamentarium of surgeons dedicated to this type of neoplasms. The collaboration of surgeons and the endoscopists allow to apply these techniques in the best way for each specific case.
