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We thank Dr Fujita for his insightful comments regarding our recent article. He also provides a nice review of other recent articles with outcomes for laparoscopic GIST resection. In response to specific questions, our series has 26 of 33 patients who had tumors smaller than 5 cm. The average tumor size was 3.9 cm and mean length of follow-up was 13 months. We agree that longer follow-up is helpful in assessing for recurrence. However, 79% of our patients fall into a low malignant potential category.
Avoidance of tumor rupture is of utmost importance during GIST resection. Tumors in difficult locations can be manipulated by use of nontraumatic graspers on the stomach wall near the tumor, avoiding direct tumor manipulation. Alternatively, a stitch can be placed near the tumor in normal tissue for retraction. We will typically approach GIST tumors with invasion into adjacent organs through an open operation, though we may begin with diagnostic laparoscopy to confirm invasion that is suspected on preoperative imaging.
Correspondence: Dr Harold, Department of Surgery, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (firstname.lastname@example.org).
Author Contributions:Study concept and design: Harold, Huguet, Rush, Schlinkert, Hinder, and Kendrick. Acquisition of data: Harold, Huguet, Rush, Tessier, Grinberg, and Kendrick. Analysis and interpretation of data: Rush. Drafting of the manuscript: Harold, Huguet, and Rush. Critical revision of the manuscript for important intellectual content: Huguet, Rush, Tessier, Schlinkert, Hinder, Grinberg, and Kendrick. Study supervision: Harold, Schlinkert, and Kendrick.
Financial Disclosure: None reported.
Harold KL, Huguet KL, Rush RM, et al. Open or Laparoscopic Resection of a Large Gastric Gastrointestinal Stromal Tumor—Reply. Arch Surg. 2009;144(2):193–197. doi:10.1001/archsurg.2008.554
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