These recommendations are based on findings of studies that only involved open surgery. Several randomized comparative studies that include both open and Pacritinib structure laparoscopic surgery should be conducted for further recommendation.
Laparoscopic approach was safely performed for the diagnosis and treatment of the submucosal tumors of the stomach because it is associated with low morbidity, mortality, and sound oncologic outcomes. However, no report on the long-term safety and efficacy of this surgery for large sized gastric GISTs has been published to date. We present a 63-year-old female case of a large gastric GIST of 19 cm removed by laparoscopic wedge resection. Keywords: GIST, Stomach, Laparoscopy, Wedge resection Introduction The term of GIST was introduced by Mazur et al.
in 1983 in order to indicate a distinct heterogeneous group of mesenchymal neoplasms characterized by spindle or epithelioid cells with varying differentiation. GISTs represent a wide clinical spectrum from benign to highly malignant tumors. Although they may arise throughout the gut, the commonest sites are stomach and small intestine (1). Recently, the origin of GISTs has been proposed to be the interstitial cell of Cajal, which is the pacemaker cell of the gastrointestinal system. Most GISTs have activating mutations of the c-kit protooncogene (CD117), a transmembrane tyrosine kinase receptor protein, that have been implicated in their tumorigenesis. These mutations lead to constitutive expression of KIT protein.
The majority of GISTs are positive for CD117 (94%), CD34 (60%�C70%) (2), a hematopoietic progenitor cell antigen, variably positive for smooth-muscle actin, and usually negative for desmin and S100 protein (3). The preoperative diagnosis of GIST is relatively difficult to make, endoscopy often failed to detect sub-mucosal and extraluminal GIST, and a biopsy specimen is often negative. Recently, fine-needle aspiration (FNA), performed under the guidance of ultrasound or computed tomography, have been developed as reliable methods to obtain tumor cells, and have allowed the preoperative diagnosis of GIST by histological examinations with immunohistochemistry (4,5). However, resection of the tumor is generally necessary, from both the diagnostic and the therapeutic aspects. Lymphadenectomy is not necessary, because gastric GISTs rarely metastasize to the lymph nodes (6).
The development of endoscopic stapling devices and the evidence that laparoscopic resection of GISTs is effective with minimal morbidity and no reported mortality (7) has made laparoscopic wedge resection a valid alternative to the conventional open approach. However, there has been controversy regarding Drug_discovery tumor size in laparoscopic surgery for gastric GISTs (8). Recent reports show that laparoscopic or laparoscopic-assisted resection may be used for small gastric GISTs (9).