Pancreas preserving surgery for duodenal gastrointestinal stromal tumor removal.

BACKGROUND: We reported our experience with high-risk, non-metastatic second portion duodenal gastrointestinal stromal tumor (GIST)s in patients who underwent 1-month neoadjuvant cycles with imatinib therapy followed by pancreas-preserving surgery and 12-month of adjuvant chemotherapic regimen including imatinib. This study was conducted to evaluate the short and long-term results. METHODS: The study was conducted between January 2010 and May 2015. Medical charts and operative logbooks of patients were retrospectively reviewed. RESULTS: Nine patients form the basis of the current analysis. All patients underwent curative resection with pancreas preservation, and all specimens had histologically negative margins. The median follow-up was 35 months. Eight patients were alive, 1 patient died for myocardial infarction at a mean follow-up of 10 months, 1 patient had a recurrence at a mean follow-up of 32 months and no patients developed distant metastases. CONCLUSIONS: We are confident to suggest the use of neoadjuvant and adjuvant Imatinib therapy to those patients affected with D2, high-risk, duodenal GISTs to allow a limited resection.

Robot-assisted laparoscopic management of cardia carcinoma according to Siewert recommendations.

BACKGROUND: Resection of cardia and upper gastric carcinoma is considered a demanding procedure in laparoscopic surgery. Robotics could aid laparoscopic dissection of the oesophago-gastric junction and oesophageal anastomosis, enlarging indications for a minimally invasive approach to these tumours. METHODS: Data from 17 consecutive patients with histologically proved cardia carcinoma were collected in a prospective database to assess the feasibility and safety of laparoscopic robot-assisted radical surgery, using the four-arm da Vinci surgical system. The type of surgery was chosen according to Siewert recommendations. Outcome measures were conversion rate, intra- and post-operative morbidity and mortality, operative time, blood loss, number of lymph nodes harvested and macroscopic and microscopic evaluation of resection margins. RESULTS: Seventeen laparoscopic operations were completed without conversion (14 extended gastrectomies, two transhiatal distal oesophagectomies and one transthoracic distal oesophagectomy). Extended lymph node dissection and oesophago-jejunal anastomosis were successfully carried out using the da Vinci system. Mean operative time was 327.2 ± 93.4 min and blood loss 279 ± 199 ml. The mean number of nodes retrieved was 28 ± 9 and all resection margins were negative. There was no mortality and overall morbidity was acceptably low (41.1%). During a mean follow-up time of 20 months, four recurrences were recorded (two multivisceral, one to the lung and one nodal), with two recurrence-related deaths. CONCLUSIONS: Robot-assisted laparoscopic radical surgery of the oesophago-gastric junction is feasible and safe. Longer follow-up time and randomized studies are needed to evaluate the long-term outcome and advantages for the patient of this new technology.