Deciding laparoscopic approaches for wedge resection in gastric submucosal tumors: a suggestive flow chart using three major determinants.

BACKGROUND: The aim of this study was to determine the optimal laparoscopic approach for wedge resection of gastric submucosal tumors (SMTs) based on tumor characteristics. STUDY DESIGN: Between March 2008 and June 2010, 57 patients underwent laparoscopic wedge resection for suspected gastric SMT. Of these 57 patients, 40 underwent exogastric wedge resection (EWR), with the remaining undergoing transgastric wedge resection (TWR). RESULTS: Fifty-seven consecutive patients undergoing surgical resection of gastric SMT were reviewed, with 40 and 17 tumors treated with EWR and TWR, respectively. The average tumor size was significantly greater in the EWR group (p = 0.004). A circular tumor location was a decisive factor for selecting the laparoscopic approach (p = 0.011). Tumors presenting with exophytic growths were predominantly found in the EWR group, and those with endophytic growth were dominant in the TWR group (p < 0.001). A multivariate analysis to determine the independent factors influencing the choice for EWR or TWR revealed that tumor size (95% CI, 1.1 to 20.0; p = 0.033) and circular location of tumor (95% CI, 1.4 to 106.9; p = 0.021) were statistically significant factors. CONCLUSIONS: These data suggest a strategy for selection of appropriate laparoscopic wedge resection strategies based on tumor characteristics. This decision is affected by tumor size, location, and growth pattern.