Laparoscopic resection of a gastrointestinal stromal tumor larger than 5 cm: Report of a Case

A 46-year-old woman was admitted to our hospital and was diagnosed with a gastric submucosal tumor at the medical examination. Upper endoscopic examination revealed a submucosal tumor in the lower body of the stomach. Abdominal computed tomography (CT) revealed a large tumor of dimensions 51 × 32 mm in the lower body of the stomach with a mixed appearance: a solid part exhibiting a contrast effect and a cystic part exhibiting no contrast. Endoscopic ultrasonic fine needle aspiration biopsy (EUS-FNAB) was performed, and a gastrointestinal stromal tumor (GIST) was diagnosed by immunohistopathological examination. Laparoscopic surgery with five ports was performed for resection. After securing the safety margin the tumor was resected circumferentially using an ultrasonically activated device (USAD). Resection entailed a significant portion of the gastric wall. During surgery, a support yarn hooked in the minor axis direction, and the defect was closed using an automatic suturing device three times. According to the third edition of the GIST clinical practice guidelines, indications for laparoscopic resection of GISTs over 5cm have been relaxed. It was considered that careful laparoscopic resection would be possible even though this was a large GIST exceeding 5 cm

Laparoscopic resection of a gastrointestinal stromal tumor larger than 5 cm: Report of a Case

A 46-year-old woman was admitted to our hospital and was diagnosed with a gastric submucosal tumor at the medical examination. Upper endoscopic examination revealed a submucosal tumor in the lower body of the stomach. Abdominal computed tomography (CT) revealed a large tumor of dimensions 51 × 32 mm in the lower body of the stomach with a mixed appearance: a solid part exhibiting a contrast effect and a cystic part exhibiting no contrast. Endoscopic ultrasonic fine needle aspiration biopsy (EUS-FNAB) was performed, and a gastrointestinal stromal tumor (GIST) was diagnosed by immunohistopathological examination. Laparoscopic surgery with five ports was performed for resection. After securing the safety margin the tumor was resected circumferentially using an ultrasonically activated device (USAD). Resection entailed a significant portion of the gastric wall. During surgery, a support yarn hooked in the minor axis direction, and the defect was closed using an automatic suturing device three times. According to the third edition of the GIST clinical practice guidelines, indications for laparoscopic resection of GISTs over 5cm have been relaxed. It was considered that careful laparoscopic resection would be possible even though this was a large GIST exceeding 5 cm

National trends in the outcomes of subarachnoid haemorrhage and the prognostic influence of stroke centre capability in Japan: retrospective cohort study

Objectives To examine the national, 6-year trends in in-hospital clinical outcomes of patients with subarachnoid haemorrhage (SAH) who underwent clipping or coiling and the prognostic influence of temporal trends in the Comprehensive Stroke Center (CSC) capabilities on patient outcomes in Japan.Design Retrospective study.Setting Six hundred and thirty-one primary care institutions in Japan.Participants Forty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database.Primary and secondary outcome measures Annual number of patients with SAH who remained untreated, or who received clipping or coiling, in-hospital mortality and poor functional outcomes (modified Rankin Scale: 3–6) at discharge. Each CSC was assessed using a validated scoring system (CSC score: 1–25 points).Results In the overall cohort, in-hospital mortality decreased (year for trend, OR (95% CI): 0.97 (0.96 to 0.99)), while the proportion of poor functional outcomes remained unchanged (1.00 (0.98 to 1.02)). The proportion of patients who underwent clipping gradually decreased from 46.6% to 38.5%, while that of those who received coiling and those left untreated gradually increased from 16.9% to 22.6% and 35.4% to 38%, respectively. In-hospital mortality of coiled (0.94 (0.89 to 0.98)) and untreated (0.93 (0.90 to 0.96)) patients decreased, whereas that of clipped patients remained stable. CSC score improvement was associated with increased use of coiling (per 1-point increase, 1.14 (1.08 to 1.20)) but not with short-term patient outcomes regardless of treatment modality.Conclusions The 6-year trends indicated lower in-hospital mortality for patients with SAH (attributable to better outcomes), increased use of coiling and multidisciplinary care for untreated patients. Further increasing CSC capabilities may improve overall outcomes, mainly by increasing the use of coiling. Additional studies are necessary to determine the effect of confounders such as aneurysm complexity on outcomes of clipped patients in the modern endovascular era