| Theme | Managements of Submucosal Tumors (SMT) in the Gastrointestinal Tract | |
|---|---|---|
| Title | Surgical Management of Gastrointestinal Submucosal Tumors | |
| Publish Date | 2018/11 | |
| Author | Yoshikazu Hashimoto | Department of Surgery, Kyorin University School of Medicine |
| Author | Nobutsugu Abe | Department of Surgery, Kyorin University School of Medicine |
| Author | Taisuke Takagi | Department of Surgery, Kyorin University School of Medicine |
| Author | Atsuko Ooki | Department of Surgery, Kyorin University School of Medicine |
| Author | Hirohisa Takeuchi | Department of Surgery, Kyorin University School of Medicine |
| Author | Gen Nagao | Department of Surgery, Kyorin University School of Medicine |
| [ Summary ] | We describe the surgical management of gastrointestinal submucosal tumors (SMTs). Endoscopic or surgical treatment should be considered in patients with gastrointestinal SMTs if the tumor is malignant such as for gastrointestinal stromal tumors or a neuroendocrine tumor (carcinoid), if it is symptomatic, and/or it measures> 2-3 cm in diameter. SMTs confined to the mucosal or submucosal layer is a good indication for endoscopic resection, involve en doscop ic mucosal resection and endoscopic submucosal/muscularis dissection. SMTs located in the deeper layers need surgical treatment using laparoscopic and endoscopic cooperative surgery (LECS), laparoscopy-assisted endoscopic full-thickness resection, or laparoscopic wedge/partial/local resection. Laparotomy and thoracotomy are performed for SMTs measuring> 5 cm in diameter. Leiomyomas constitute 70 % of esophageal SMTs, and nuclear excision is often sufficient. Small bowel SMTs require surgical treatment to avoid the future risk of hemorrhage and/or bowel obstruction. Surgery performed for most gastrointestinal SMTs does not require lymphadenectomy or wide surgical margins. Thus, minimally invasive approaches using endoscopic/laparoscopic surgery need to be explored in this context. | |