STOMACH TUMORS AND LAPAROSCOPIC SURGERY. WHAT THE STATUS IS NOWADAYS.
The stomach is a place for the development of a wide variety of tumors that, depending on their biological behavior, can be characterized as benign (hyperplastic polyps, inflammatory pseudopolypods, lipomas, leiomyomas, etc.), potentially malignant (adenomas, lymphomas, lymphomas, stratified tumors), and malignant (adenocarcinomas, etc.). Potentially malignant are tumors that, if left untreated, can develop into carcinomas.
The diagnosis is made by gastroscopy and the result of the endoscopic biopsy determines the further laboratory and imaging examination.
Malignant and potentially malignant tumors need immediate treatment. Among the benign tumors, those that cause symptoms, bleed, or have a non-diagnostic biopsy are the ones that are surgically treated.
Traditionally, gastric surgery involves the resection of the lower part, 2/3 or even of the whole organ depending on the location of the tumor and the operation is completed with corresponding techniques, each time, in order to restore the continuity of the digestive tract. These are operations of great importance and entail many possible, early and distant, complications. However, studies of the biological behavior of tumors have concluded that local resection is sufficient for benign and potentially malignant tumors, provided that it is performed on healthy tissue. Thus, the wedge-shaped resection of the affected wall was established at very narrow limits, which dramatically reduced the severity and complications of the old approach, as no further manipulations and anastomoses were necessary.
The revolution in laparoscopic surgery and the universal acceptance of its advantages have taken its place in gastric surgery, to the extent that it has almost completely replaced all open techniques. For example, the wedge resection of a stratum corneum is completed laparoscopically in a short time with the application of an automatic cutter, without bleeding and with minimal complications. The patient is discharged from the hospital shortly after, returning to his daily activities.
However, the use of laparoscopic tools removed the surgeon’s sense of touch, greatly limiting the possibility of treating small tumors. This problem was initially approached with pigments that “colored” the tumor, making it visible with a laparoscope. However, their use caused various unwanted events, on one hand and spread to the surrounding tissues, on the other, leading to much wider excisions than the desired.
Nowadays, for benign and potentially malignant tumors of the stomach, their combined “hybrid” treatment is universally accepted – laparoscopic, endoscopically assisted. A large number of studies in the medical literature have established the technique’s stand for about a decade. According to the methodology of this approach, within the operating room, the endoscope locates and signifies the tumor with the gastroscope, the surgeon excises the part of the gastric wall that brings the lesion under direct vision without damaging the adjacent neighboring healthy tissue immediately while checking and allowing interventions at the same time.
For malignant tumors, wide excisions are still a one-way street. In recent years in Japan, which has the highest global incidence of stomach cancer, the hybrid approach has been applied even to one type of cancer, early gastric cancer. It is a cancer that is strictly located in the very superficial part of the inside of the stomach, the mucosa, and the resection of the pathology means its healing. The above does not apply if the neoplasm has deeply exceeded the absolute limits of the mucosa.
In conclusion, benign and potentially malignant tumors of the stomach can be treated with modern, minimally invasive techniques that offer healing with the least possible strain on the body. The surgeon, with the help of the endoscope, has a simultaneous image of the outside and the inside of the stomach, excising a gastric tumor accurately and without any complications. In the case of carcinomas, wide excisions are oncologically unavoidable, but with the laparoscopic technique they are less arduous, painful and unpleasant for the patient.