Pitfalls in Intragastric Surgery in the Treatment of Gastric Stromal Tumors

I am performing a variety of operative procedures for gastric stromal tumors, because as far as it can be treated by local excision without lymphadenectomy, I am convinced, we have to preserve the stomach as much as possible for the better quality of life of the patients. In this context, the operative procedure should be tailored according to the particular characteristics of each tumor, such as precise location, size, shape, type of growth, and so on. 

Intragastric surgery is performed based on this policy, and its occupancy rate among all modalities for gastric submucosal tumors in our hospital is now about 33%.　

I have been performing intragastric surgery since 1993. At the beginning I inserted 3 trocars into the stomach percutaneously. But I modified this operation to be a single incision surgery 18 years later, which was 2011. 

This time, I would like to focus on two complicated situations. One is perforation, and the other difficulty in selection. 



https://pubmed.ncbi.nlm.nih.gov/28616604/



Kanehira E, Kanehira AK, Tanida T, Takahashi K, Sasaki K. Percutaneous endoscopic intragastric surgery: an organ preserving approach to submucosal tumors at esophagogastric junction. Transl Gastroenterol Hepatol. 2017 May 16;2:48. doi: 10.21037/tgh.2017.05.03. PMID: 28616604; PMCID: PMC5460174.



https://pubmed.ncbi.nlm.nih.gov/26201418/



Kanehira E, Kamei A, Umezawa A, Kurita A, Tanida T, Nakagi M. Long-term outcomes of percutaneous endoscopic intragastric surgery in the treatment of gastrointestinal stromal tumors at the esophagogastric junction. Surg Endosc. 2016 May;30(5):2036-42. doi: 10.1007/s00464-015-4439-8. Epub 2015 Jul 23. PMID: 26201418.



https://pubmed.ncbi.nlm.nih.gov/30941549/



Kanehira E, Kanehira AK, Tanida T, Takahashi K, Obana Y, Sasaki K. CLEAN-NET: a modified laparoendoscopic wedge resection of the stomach to minimize the sacrifice of innocent gastric wall. Surg Endosc. 2020 Jan;34(1):290-297. doi: 10.1007/s00464-019-06765-3. Epub 2019 Apr 2. PMID: 30941549.