Endoscopic tunnel dissection and its role in the treatment of gastrointestinal stromal tumors of the stomach

Abstract

Background: To determine the effectiveness of submucosal tunnel dissection in patients with gastrointestinal stromal tumors. Methods and materials: Since March 2014 24 patients were operated with gastrointestinal stromal tumors with a tunneling method. 27 tumors were removed. Among patients there were 3 men and 21 women. The average age of patients was 62,8 years old. Among operated there were as patients with first identified tumors, as patients who were under a doctor’s care for a long time about submucosal tumors. Surgical indication for these patients was a negative dynamics according to endosonographies in the form of increasing the size of the tumor and the change of structure. The average size of tumor was 19 mm. The nature of operation is in the formation of tunnel in submucosa through mucous membrane’s incision and enucleation of tumor with protecting the integrity of capsule. Results: All surgeries were carried out endotracheal anesthesia. Intraoperative carboxyperitoneum occurred in 4 patients, it was contained by abdominal decompression with the help of verres needle. No other intraoperative complications were observed. Based on IHC test, nine removals of neoplasms of the stomach were low-grade gastrointestinal stromal tumors, seven tumors were related to intermediate group. Seх tumors, including small tumors of multiple lesions, were leiomyomas. Two patients refused from spending IHC test. Conclusion: Endoscopic tunnel operations are technically feasible and can be used in the surgical treatment of small submucous tumors of myogenic origin. The introduction of minimally invasive methods is based on the observation that small gastrointestinal stromal tumors are limited to fibrous capsule and through this don’t metastasize in lymph nodes. Oncological evidence is based on the absence of recurrence and progression of the disease over the observation period. Besides, a minimal access significantly reduces the number of complications and a period of patients’ rehabilitation after operation.