Background Gastro-Intestinal Stromal Tumors (GISTs) are the most common mesenchymal tumors of gastrointestinal tract and stomach is the most frequent localization. The role of minimally invasive surgery of gastric GISTs is still unclear, particularly for big and difficult located tumors such as tumors of posterior wall, gastroesophageal junction and antrum. We herein present our single center experience in robotic surgery of gastric GISTs with da Vinci Si and Xi. Materials and methods Data of patients undergoing robot-assisted treatment of gastric GIST at our centre were retrieved from our prospectively-collected institutional database and a retrospectively analyzed. Patients were stratified according to the localization of the tumor. Results Between May 2010 and February 2017, 12 patients underwent robot-assisted gastric surgery for GIST at our Institution. Locations of the tumor were: fundus/greater curvature in 4 patients, antrum in 2 patients, lesser curvature in 3 patients, gastro-esophageal junction in one patient and posterior wall in 2 patients. Mean tumor size was 3,9 (1,8 - 6) cm. The da Vinci Si robot was used in 8 cases, da Vinci Xi in 4. Robot-assisted wedge resection was performed in all cases. Operative time was shorter with da Vinci Xi (107 min versus 170 min; p=0.04). All lesions had microscopically negative resection margins. No conversion to open surgery, no tumor ruptures or spillage and no intra-operative complications occurred. Conclusion In our experience, da Vinci robot has simplified the execution of gastric resections, particularly in challenging case for minimal invasive surgery, regardless of location or size. Robotic approach could give some advantages by facilitating dissection, exposure and mostly reconstruction in gastric surgery for GISTs. All these advantages could translate into a more widespread use of minimally invasive approach and high rate of gastric parenchyma sparing surgery in this setting. The da Vinci Xi could further improve the results.

GASTROINTESTINAL STROMAL TUMORS (GISTS) OF STOMACH: ROBOT-ASSISTED EXCISION WITH THE DA VINCI SI AND XI REGARDLESS OF SIZE AND TUMOR LOCALIZATION

FURBETTA, NICCOLO';PALMERI, MATTEO;GUADAGNI, SIMONE;Di Franco, G;GIANARDI, DESIRÉE;MOGLIA, ANDREA;MOSCA, FRANCO;MORELLI, LUCA
2017-01-01

Abstract

Background Gastro-Intestinal Stromal Tumors (GISTs) are the most common mesenchymal tumors of gastrointestinal tract and stomach is the most frequent localization. The role of minimally invasive surgery of gastric GISTs is still unclear, particularly for big and difficult located tumors such as tumors of posterior wall, gastroesophageal junction and antrum. We herein present our single center experience in robotic surgery of gastric GISTs with da Vinci Si and Xi. Materials and methods Data of patients undergoing robot-assisted treatment of gastric GIST at our centre were retrieved from our prospectively-collected institutional database and a retrospectively analyzed. Patients were stratified according to the localization of the tumor. Results Between May 2010 and February 2017, 12 patients underwent robot-assisted gastric surgery for GIST at our Institution. Locations of the tumor were: fundus/greater curvature in 4 patients, antrum in 2 patients, lesser curvature in 3 patients, gastro-esophageal junction in one patient and posterior wall in 2 patients. Mean tumor size was 3,9 (1,8 - 6) cm. The da Vinci Si robot was used in 8 cases, da Vinci Xi in 4. Robot-assisted wedge resection was performed in all cases. Operative time was shorter with da Vinci Xi (107 min versus 170 min; p=0.04). All lesions had microscopically negative resection margins. No conversion to open surgery, no tumor ruptures or spillage and no intra-operative complications occurred. Conclusion In our experience, da Vinci robot has simplified the execution of gastric resections, particularly in challenging case for minimal invasive surgery, regardless of location or size. Robotic approach could give some advantages by facilitating dissection, exposure and mostly reconstruction in gastric surgery for GISTs. All these advantages could translate into a more widespread use of minimally invasive approach and high rate of gastric parenchyma sparing surgery in this setting. The da Vinci Xi could further improve the results.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11568/873752
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