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Priego et al. Mini-invasive Surg 2018;2:6 I http://dx.doi.org/10.20517/2574-1225.2018.01 Page 5 of 7

Table 1. Demographic characteristics of patients
Case 1 Case 2 Case 3 Case 4
Age (year)/gender 82/M 74/F 78/F 64/F
ASA III II II III
Comorbidities COPD, DM Hypertension Hypertension, DM, DL Hypertension, dilated
myocardiopathy,
ischemic cerebrovascular
accident
Symptoms Haematemesis Haematemesis Epigastric pain Epigastric pain
Diagnosis Endoscopy, Endoscopy, Endoscopy, Endoscopy,
CT scan Eco-endoscopy, Eco-endoscopy, Eco-endoscopy,
CT scan CT scan, CT scan
Barium swallow
MRI
Hystopathology GIST low malignancy, GIST low malignancy, mitotic Leiomyoma Leiomyoma
mitotic index < 5/50 index
< 5/50
Size tumor (cm) 5.5 3 3 2.3
Operative time (min) 120 195 145 232
Intraoperative complications None None None Methilene blue leakage
Postoperative complications None None None Fever, haematemesis
Oral intake (days) 3 2 3 10
Hospital stay (days) 7 4 6 15
Mortality No No No No
M: male; F: female; ASA: American Society of Anesthesiologists; COPD: chronic obstructive pulmonary disease; DM: diabetes mellitus;
CT: computerized tomography; GIST: gastrointestinal stromal tumors; DL: dyslipemia; MRI: magnetic resonance imaging

The mean operation time was 173 min (range 120-232 min). There were no conversions. There were no
intraoperative complications, but in one of the patients, a methylene blue leakage was observed when
suture was checked, which was reinforced. No postoperative complications were described, but patient
with methylene blue leakage experimented hyperpyrexia in the first 24 h after operation and haematemesis.
Both problems were treated conservatively.

The mean postoperative stay was 8 days (range 4-15 days). There was no death in our series.

At a mean follow-up of 31 months, all of our patients are asymptomatic and free of recurrence. None
showed evidence of stenosis of the EGJ or acid reflux symptoms.

DISCUSSION
Laparoscopic wedge resection is widely accepted as a choice of treatment for GST, especially for tumors in
the anterior wall, lesser curvature, and greater curvature. However, tumors on the posterior wall at the EGJ
[1-5]
remain difficult to approach .
[6]
Privette et al. proposed a tailored location-based standardized approach to resection of gastric GIST. This
new classification on the basis of tumor location considers type 1 tumors located in fundus and greater
curvature, type 2 for tumors in the antrum-prepyloric region and type 3 for tumors in the lesser curvature
and EGJ. The surgical approach as dictated by tumor location would be a laparoscopic wedge resection for
type 1, a laparoscopic distal gastrectomy for large type 2 tumors, and a laparoscopic transgastric resection
for type 3.

The optimal approach to GISTs located near EGJ is not well defined. Such tumors have been reported as
[7]
the reason for conversion, planned open procedure, and exclusion indication for laparoscopic approach .

Several laparoscopic approaches have been described for the surgical treatment of gastric GIST near the