Treatment Options for Gastric Leiomyoma

Gastric leiomyoma can be challenging to distinguish from leiomyosarcoma, and since these tumors have the potential to become malignant, prompt medical intervention is strongly recommended. For small, single, and pedunculated tumors less than 2cm in diameter, endoscopic electrocautery is often a suitable and minimally invasive treatment option. Endoscopic resection offers faster recovery, lower costs, and minimal trauma compared to surgical methods.

However, if the tumor is larger than 2cm, multiple, sessile, or associated with symptoms such as bleeding or obstruction, more aggressive treatment may be necessary. In such cases, laparoscopic or open surgical removal should be considered. If biopsy results indicate potential malignancy, immediate surgical intervention is crucial.

For tumors located in the body, antrum, or fundus of the stomach measuring less than 5cm, local excision may be performed if the tumor is well-defined, shows no signs of necrosis, and is not associated with mucosal ulceration or metastasis. Surgeons typically aim to remove a margin of about 1cm around the tumor to ensure complete resection.

Tumors located near the pylorus or cardia require special attention. When the tumor is less than 3cm in diameter, conservative local excision or wedge resection with part of the gastric wall may be performed. Smaller tumors, particularly those under 2cm, can usually be removed via endoscopic submucosal dissection.

In summary, the choice of treatment depends on the size, location, and biological behavior of the tumor. Endoscopic removal is ideal for small lesions, while larger or symptomatic tumors often require laparoscopic or open surgery. Early diagnosis and appropriate management are key to preventing complications and ensuring a favorable prognosis.