摘要
One of the most prominent characteristics of gastrointestinal stromal tumors(GISTs) is their unpredictable and variable behavior. GISTs are not classified as "benign" or "malignant" but are rather stratified by their associated clinical risk of malignancy as determined by tumor size, location, and number of mitoses identified during surgicalhistology. The difficulty in assessing the malignant potential and prognoses of GISTs as well as the increasing incidence of "incidental GISTs" presents challenges to gastroenterologists. Recently, endoscopic enucleation has been actively performed as both a diagnostic and therapeutic intervention for GISTs. Endoscopic enucleation has several advantages, including keeping the stomach intact after the removal of GISTs, a relatively short hospital stay, a conscious sedation procedure, relatively low cost, and fewer human resources required compared with surgery. However, a low complete resection rate and the risk of perforation could reduce the overall advantages of this procedure. Endoscopic full-thickness resection appears to achieve a very high R0 resection rate. However, this technique absolutely requires a very skilled operator. Moreover, there is a risk of peritoneal seeding due to large active perforation. Laparoscopy endoscopy collaborations have been applied for more stable and pathologically acceptable management. These collaborative procedures have produced excellent outcomes. Many procedures have been developed and attempted because they were technically possible. However, we should first consider the theoretical basis for each technique. Until the efficacy and safety of sole endoscopic access are proved, the laparoscopy endoscopy collaborative procedure appears to be an appropriate method for minimally destructive GIST surgery.
One of the most prominent characteristics ofgastrointestinal stromal tumors （GISTs） is theirunpredictable and variable behavior. GISTs arenot classified as ＂benign＂ or ＂malignant＂ but arerather stratified by their associated clinical risk ofmalignancy as determined by tumor size, location,and number of mitoses identified during surgicalhistology. The difficulty in assessing the malignantpotential and prognoses of GISTs as well as theincreasing incidence of ＂incidental GISTs＂ presentschallenges to gastroenterologists. Recently, endoscopicenucleation has been actively performed as both adiagnostic and therapeutic intervention for GISTs.Endoscopic enucleation has several advantages,including keeping the stomach intact after the removalof GISTs, a relatively short hospital stay, a conscioussedation procedure, relatively low cost, and fewerhuman resources required compared with surgery.However, a low complete resection rate and the risk ofperforation could reduce the overall advantages of thisprocedure. Endoscopic full-thickness resection appearsto achieve a very high R0 resection rate. However, thistechnique absolutely requires a very skilled operator.Moreover, there is a risk of peritoneal seeding dueto large active perforation. Laparoscopy endoscopycollaborations have been applied for more stableand pathologically acceptable management. Thesecollaborative procedures have produced excellentoutcomes. Many procedures have been developed andattempted because they were technically possible.However, we should first consider the theoretical basisfor each technique. Until the efficacy and safety ofsole endoscopic access are proved, the laparoscopyendoscopy collaborative procedure appears to be anappropriate method for minimally destructive GISTsurgery.
基金
Supported by The Science Research Program through the National Research Foundation of Korea(NRF)
the Ministry of Science,ICT and Future Planning,No.NRF-2013R1A1A1009682
