Surgical treatment of gastric and small bowel gastrointestinal stromal tumours

AIM: This study aimed to evaluate a set of gastrointestinal stromal tumours (GIST) of the stomach and the small bowel managed with a laparoscopic technique. MATERIAL AND METHODS: The study covers a period from January 1, 2007 until June 1, 2010 during which 13 patients underwent the laparoscopic removal of stomach tumours and 2 patients underwent the removal of a small bowel GIST in the General Hospital in Pardubice. In all cases tumours were removed in a laparoscopic way, including the healthy border of the stomach tissue. RESULTS: No death was observed in our study. Two patients suffered from wound infection (secondary healing), one of them requiring repeat surgery owing to the excessive narrowing of the distal part of the stomach. Dehiscence of laparoscopic sutures or other intra-abdominal complications were not observed. During monitoring all patients were free of signs of local recurrence, but tumour progression into the liver was observed in 1 patient. Gastrointestinal stromal tumours are very rare tumours but their incidence is increasing. At this time the consensus about the necessity of preoperative unambiguous differentiation between malignant or less malignant variants is not available. Strict differentiation is very difficult and the decision whether to choose a more radical surgical approach for more malignant variants is not clear-cut. CONCLUSIONS: In cases of gastric and small bowel GISTs the local removal of a tumour with the healthy border of the stomach tissue may be chosen as an adequate approach. Our results support this local surgical approach.