Robot-assisted resection may be safe and effective at removing difficult-to-reach gastric gastrointestinal stromal tumors (GISTs), according to a novel study published by Lwin et al in the Journal of Surgical Research.
Background
For gastric GISTs, surgery is the standard treatment option; however, gastric GISTs situated in hard-to-reach locations of the stomach such as the gastroesophageal junction or lesser curvature often present unique challenges—especially with laparoscopic surgery. In particular, it may be difficult to completely remove the tumor while also preserving organ function.
The most common approach for surgical removal of gastric GISTs is a stapled gastric wedge resection, where the GIST is treated by using a linear stapler to remove a wedge-shaped portion of the stomach and close the wound at the same time. For gastric GISTs positioned in certain parts of the stomach or inward growth tumors, this is not a viable option.
For instance, following the removal of a tumor in the gastroesophageal junction, stapling the tissue may damage the proximal sphincter. If the proximal sphincter is compromised, the patient could experience problems such as heartburn or difficulty swallowing.
At the lower end of the stomach, a stapled gastric wedge resection could also put the distal sphincter at risk. Loss of function could lead to dumping syndrome, in which food quickly passes into the small intestine without being digested. The many unpleasant symptoms of dumping syndrome include diarrhea, nausea, and vomiting.
Study Methods and Results
In the new study, researchers enrolled 25 consecutive patients who underwent a robot-assisted partial gastrectomy from 2019 to 2021. The patients’ tumors were located at the gastroesophageal junction (n = 12), lesser curvature (n = 7), posterior gastric wall (n = 4), fundus (n = 3), greater curvature (n = 3), and antrum (n = 2).
The researchers discovered that using a robotic surgical platform for GIST resection offered many advantages over laparoscopic or open surgery. Visibility into challenging anatomic locations was far greater with the 10× magnification and three-dimensional view. Additionally, the robotic arms operated by the surgeon were much steadier, which reduced the risk of error, facilitated complete tumor removal, and allowed for very fine suturing to minimize damage to the surrounding tissue.
Conclusions
The researchers highlighted that robotic-assisted resection of difficult-to-reach gastric GISTs was successfully performed while also preserving the gastroesophageal junction and pylorus for all of the patients.
"We have seen that the robotic approach enables us to perform GIST and other forms of oncological surgery without compromising the extent of tumor removal or the patient's quality of life," concluded senior study author Jiping Wang, MD, PhD, Associate Professor of Surgery at Harvard Medical School as well as Research Director of the Division of Surgical Oncology and Director of Minimally Invasive Gastric Surgery at the Brigham and Women’s Hospital.
Disclosure: For full disclosures of the study authors, visit journalofsurgicalresearch.com.
