gms | German Medical Science

Introduction: Incidental gastrointestinal stromal tumors can be observed during obesity surgery and challenges the bariatric surgeon to perform bariatric procedure with optimal oncological resection. We hypothesized that complete resection of gastric GISTs during laparoscopic sleeve gastrectomy and Roux- en-Y Gastric Bypass result in low perioperative morbidity and effective long-term control of the disease.

Material and methods: From 2010 to 2014, 2603 patients underwent LSG and RYGB at Krankenhaus Sachsenhausen, which is a center of excellence for bariatric surgery. All cases with incidental GISTs found at time of laparoscopic exploration and confirmed by pathology were reviewed. Data collection included the following: gender, age, body mass index, comorbidities, intra-operative findings, surgical resection, histopathologic characteristics of the tumor and follow up data.

Results: 2603 patients underwent LSG (n = 892) and RYGB (n = 1711) in the time between 01/2010 and 03/2014. 8 patients, mean age 54 years (range 46-70 years), underwent bariatric surgery founding an incidental asymptomatic GIST (incidence 0.31%). Mean tumor size was 7.65mm (range 2.5-13 mm) with the majority of the lesions located in the fundus of the stomach. Mean operative time was 57 minutes (range 45-74 minutes) and the mean length of hospitalization was 5.1 days (range 5-6 days). There were no major perioperative complications or mortalities. All lesions had negative resection margins. All patients had 5 or less mitotic figures per 50 high power fields. At a mean follow-up of 30 months (range 5-55 months), 8 (100%) patients were disease free. No local or port site recurrences have been identified.

Conclusion: A laparoscopic approach to surgical resection of gastric GIST during bariatric surgery is associated with low morbidity and normal hospitalization. The long-term disease-free survival of 100% in our study establishes laparoscopic wedge resection during RYGB and LSG as safe and effective in treating gastric GISTs < 2cm.