Laparoscopic resection of the gastric stromal tumor. M?DE YERLE?L?ML? B?R GASTRO?NTEST?NAL STROMAL TüM?RüN LAPAROSKOP?K REZEKS?YONU.

摘要

Gastrointestinal stromal tumors are mesenchymal tumors that generally occur in gastrointestinal tract. These patients usually present with abdominal pain and discomfort, gastrointestinal bleeding and abdominal mass. The first treatment choice is complete surgical resection if possible. The prognosis depends on tumor diameter, mitosis and C-kit mutation. A 56 years-old female patient presented with abdominal pain and discomfort. Upper GI endoscopy showed a 4x3 cm polypoid mass on the major curvatura of the stomach. The histopathological examination of the biopsies taken during upper GI endoscopy was not meaningful and we decided to perform surgical resection. The margins of the mass was marked with methylene blue to find out the mass and the margins easily during surgery. We performed laparoscopic wedge resection of the mass with 4 trochars. The patient recovered from the surgery with no complications. The patient was discharged on postoperative day 2. Gastrointestinal stromal tumors are generally seen in 5. and 6. decades. The incidence of GIST is 2:100000. The patients are usually asympthomatic in the early stages and 50 % of the patients have metastasis at the diagnosis. The first treatment choice for GIST is complete surgical resection. Laparoscopic resection can be safely performed if the localisation and the diameter of mass is appropriate. ?zet Gastrointestinal stromal tüm?rler (GIST) s?kl?kla midede yerle?en mezenkimal tüm?rlerdir. Klinik bulgular? s?kl?kla kar?n a?r?s?, gastrointestinal (GiS) kanama ve kar?nda kitle ?eklindedir. Tedavide ilk se?enek cerrahi rezeksiyondur. Hastal???n prognozu hakk?nda en ?nemli belirleyiciler tüm?r büyüklü?ü, mitoz varl???, c-kit gen mutasyonu pozitifli?idir. Kar?n a?r?s? ?ikayeti ile 56 ya??ndaki kad?n hasta poliklini?e ba?vurdu. üst G?S endoskopisinde mide korpusta, büyük kurvaturda 4x3 cm ?ap?nda polipoid kitle saptanarak biyopsi al?nd?. Kitleden al?nan yüzeyel endoskopik biyopsilerde anlaml? bir patoloji saptanmad? ve cerrahi rezeksiyon karar? al?nd?. Laparoskopik wedge rezeksiyon planlanan hastada, operasyon ?ncesi endoskopi ile kitlenin s?n?rlar? metilen mavisi ile i?aretlendi. Laparaskopik wedge rezeksiyon uygulanan hasta P.O 2 günde taburcu edildi. Sonu? olarak, GIST genellikle 5. ve 6. dekatta ortaya ??kar ve insidans? 100.000’de 2’dir. Hastalar erken d?nemde genelde asemptomatiktir ve tan? an?nda hastalar?n %50’sinde metastaz mevcuttur. GIST tedavisinde tam rezeksiyon hala tek kür se?ene?idir ve uygun büyüklük ve lokalizasyondaki tüm?rlerde laparoskopi güvenle kullan?labilir.