Clinical outcomes of laparoscopic and endoscopic cooperative surgery for submucosal tumors on the esophagogastric junction: a retrospective single-center analysis

Background: Laparoscopic and endoscopic cooperative surgery (LECS) technique for gastric submucosal tumor (SMT) has developed, but treatment of SMT on the esophagogastric junction (EGJ) remains technically difficult because excessive resection may result in postoperative transformation of the EGJ and cause stenosis, and intervention to lower esophageal sphincter may result in gastroesophageal reflux. The study aim was to evaluate the feasibility and safety of LECS for SMT on the EGJ. Methods: Between September 2012 and December 2018, LECS was performed for 21 patients with SMTs on the EGJ. Fundoplication was performed after LECS according to the intraoperative findings for each case. The patients’ backgrounds, operative outcomes, and follow-up data, including endoscopic findings of gastroesophageal reflux disease (GERD) and proton pomp inhibitor (PPI) use, were reviewed. Results: In all 21 cases, LECS was completed with a mean operation time of 225 min, and a mean blood loss of 8.8 mL. All patients were alive without recurrence within the mean follow-up period of 30.5 months. Both GERD and PPI use tended to be less frequent when fundoplication was performed, although these differences were not statistically significant. (7.7% vs. 37.5%; P = 0.091, 23.1% vs. 50.0%; P = 0.204, respectively). Conclusions: We demonstrated the feasibility and safety of LECS for SMTs even on the EGJ. Fundoplication after LECS may be an approach for the prevention of postoperative reflux esophagitis. Future research is warranted to validate the efficacy of the addition of fundoplication.