Combination of Laparoscopic and Endoscopic Approaches to Neoplasia with Non-exposure Technique (CLEAN-NET) for GIST with Ulceration.

Combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique (CLEAN-NET) was developed to avoid intraoperative tumor dissemination. We report two cases of gastric gastrointestinal stromal tumor (GIST) with ulceration surgically treated with CLEAN-NET at our institution. The first case was a 55-year-old male with hematemesis. Gastric endoscopy revealed a gastric GIST with ulceration of the fornix. CLEAN-NET was performed with the insertion of five trocars and a liver retractor. The operative time was 202 min (including cholecystectomy), with a perioperative blood loss volume of 29 ml; the postoperative hospital stay duration was 8 days. The second case was a 66-year-old male with a gastric submucosal tumor (SMT) with ulceration. CLEAN-NET was performed in a similar fashion to the first case. The operative time was 128 min, with a preoperative blood loss volume of 16 ml; the postoperative hospital stay duration was 9 days. In conclusion, CLEAN-NET was found to be safe and useful in the treatment of gastric GIST with ulceration.