Technical considerations in laparoscopic resection of gastric neoplasms

Background: The purpose of this study was to determine the use of different laparoscopic approaches in the management of gastric neoplasms based on tumor type and location. Methods: We retrospectively reviewed the records of seven patients (3 men and 4 women) with 11 gastric lesions who were referred to our facility between March 2000 and October 2001 for laparoscopic excision of gastric neoplasms. Results: Two patients had gastrointestinal stromal lesions (3 lesions); two patients had hyperplastic polyps (3 lesions); one patient had carcinoid tumor (2 lesions); one patient had a carcinoma in situ and an adenoma; and one patient had an ectopic pancreas. Extraluminal laparoscopic wedge resection was used in four patients with lesions at the anterior gastric wall or along the lesser or greater curvature. Intragastric excision was used in two patients with small posterior wall lesions, and a transgastrotomy approach was used in one patient with a posterior wall lesion that could not be removed by the intragastric approach. All the lesions were completely excised with clear margins. The median hospital stay was 3 days. Complications developed in two patients. One patient presented with a perforated ulcer 2 weeks after surgery, and a second patient had postoperative pyloric edema that resolved with conservative treatment. Conclusions: The use of different laparoscopic approaches based on gastric neoplasm type and location facilitates tumor access and resection.