Minimally invasive options for gastric tumors

INTRODUCTION: Depending on the origin of the tumor tissue, gastric tumors may be more or less accessible for biopsy diagnostics. However, especially submucous tumors present a diagnostic problem. Entity and dignity may remain unclear particularly in larger tumors and may not be clarified before operative excision via gastrotomy and frozen section diagnostics. Similar problems may occur in the diagnostics of epithelial tumors, if a reliable appraisal of the dignity based on forceps biopsy is impossible. To clarify their entity and dignity, tumors can be completely extirpated with minimally invasive techniques. PATIENTS AND METHODS: Apart from the endoscopic mucosa resection (EMR), laparoscopic intragastric tumor resection and laparoscopic wedge resection were performed, especially in larger tumors. In the period from December 1999 to December 2001, we saw an indication for minimally invasive procedures in 22 patients. There were 5 cases of submucous tumors of unclear entity and 17 epithelial lesions. The epithelial lesions included 12 patients with tumors of unclear dignity and five cases with early gastric carcinomas. RESULTS: The EMR was performed without complications in all 14 cases. One of the three cases with wedge resection was followed by a gastrectomy for oncological reasons. One early postoperative bleeding occurred, which was controlled laparoscopically. Conversion to open surgery due to technical problems was necessary in two cases of laparoscopic intragastric resection, and in one case a gastrectomy was required for oncological intention. CONCLUSION: Beside the diagnostic aspect, the mentioned techniques also enable a minimally invasive therapy of locally excisable gastric tumors. In addition to benign and low grade malignant lesions, early gastric carcinomas of the intestinal type present an indication.