Laparoscopic Resection of Gastrointestinal Stromal Tumor (GIST)

The laparoscopic approach is widely accepted surgical treatment for gastrointestinal submucosal tumors.The indication for a laparoscopic approach has been related to tumor size. The upper limit of tumor size has increased, according to recent trends, and there is no established guideline for a lower limit. While maintaining the principle of local resection with a negative resection margin, different surgical techniques are required depending on the location and configuration of the tumor. Exogastric approach is predominantly applied for exophytic tumors at the gastric anterior wall. If gastrointestinal submucosal tumors are located at the gastric posterior wall, the appropriate approach is adopted according to whether the tumor is exophytic or endophytic. If it is possible to mobilize and rotate the stomach, the exogastric approach can be applied for an exophytic lesion. However, an endophytic lesion mostly requires the more complex approaches, since the tumor localization is not easy during laparoscopic surgery. In general, either transgastric or intragastric approach can be applied.