Safety and feasibility of laparoscopy-assisted surgery for gastrointestinal stromal tumors larger than 5 cm: Results of a retrospective, single-center series of 1,802 consecutive patients



      The role of laparoscopy-assisted resection for treating gastrointestinal stromal tumors >5 cm is still disputed. We aimed to assess the advantages of laparoscopy-assisted resection for treating gastrointestinal stromal tumors >5 cm.


      In total, 1,802 patients with primary gastrointestinal stromal tumors who underwent laparoscopy-assisted surgery or open surgery were retrospectively evaluated. Propensity score matching was performed to reduce confounders.


      In total, 518 patients with tumor size >5 cm were enrolled in this study (males: 292, 56.4%; females: 226, 43.6%; median age: 58 years, range: 23–85 years). One hundred and twenty-three (23.7%) patients underwent laparoscopy-assisted resection, and 395 (76.3%) patients underwent open resection. After propensity score matching, 190 patients were included (95 in each group). The laparoscopy-assisted surgery group was superior to the open surgery group considering the blood loss (>200 mL: 6.3% vs 22.1%, P = .005), length of midline incision (6.0 ± 0.9 cm vs 9.6 ± 2.1 cm, P < .001), time to first flatus (49.7 ± 10.5 hours vs 63.9 ± 7.4 hours, P < .001), and shorter hospital stay (10.3 ± 3.2 days vs 11.9 ± 2.9 days, P < .001). The difference in relapse-free survival or overall survival between the laparoscopy-assisted surgery and open surgery groups after matching was not significant (all P > .05). On subgroup analysis, the relapse-free survival and overall survival of the laparoscopy-assisted surgery group were comparable to those of the open surgery group, irrespective of tumor location (gastric or nongastric locations) (all P > .05).


      When performed by experienced surgeons, laparoscopy-assisted resection is feasible and safe for gastrointestinal stromal tumors >5 cm, which showed improved short-term outcomes and comparable oncological outcomes, regardless of whether the tumor had a gastric or nongastric location.
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        • Lukaszczyk J.J.
        • Preletz Jr., R.J.
        Laparoscopic resection of benign stromal tumor of the stomach.
        J Laparoendosc Surg. 1992; 2: 331-334
        • Demetri G.D.
        • Benjamin R.S.
        • Blanke C.D.
        • et al.
        NCCN Task Force report: management of patients with gastrointestinal stromal tumor (GIST)—update of the NCCN clinical practice guidelines.
        J Natl Compr Canc Netw. 2007; 5: S1-29
        • von Mehren M.
        • Kane J.M.
        • Bui M.M.
        • et al.
        NCCN guidelines insights: soft tissue sarcoma, version 1.2021.
        J Natl Compr Canc Netw. 2020; 18: 1604-1612
        • Xiong W.
        • Xu Y.
        • Chen T.
        • et al.
        Laparoscopic vs. open surgery for gastrointestinal stromal tumors of esophagogastric junction: a multicenter, retrospective cohort analysis with propensity score weighting.
        Chin J Cancer Res. 2021; 33: 42-52
        • Liao G.Q.
        • Chen T.
        • Qi X.L.
        • et al.
        Laparoscopic management of gastric gastrointestinal stromal tumors: a retrospective 10-year single-center experience.
        World J Gastroenterol. 2017; 23: 3522-3529
        • Piessen G.
        • Lefèvre J.H.
        • Cabau M.
        • et al.
        Laparoscopic versus open surgery for gastric gastrointestinal stromal tumors: what is the impact on postoperative outcome and oncologic results?.
        Ann Surg. 2015; 262: 831-839
        • Khoo C.Y.
        • Goh B.K.P.
        • Eng A.K.H.
        • et al.
        Laparoscopic wedge resection for suspected large (≥5 cm) gastric gastrointestinal stromal tumors.
        Surg Endosc. 2017; 31: 2271-2279
        • Joensuu H.
        Risk stratification of patients diagnosed with gastrointestinal stromal tumor.
        Human Pathol. 2008; 39: 1411-1419
        • Dindo D.
        • Demartines N.
        • Clavien P.A.
        Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.
        Ann Surg. 2004; 240: 205-213
        • Ahmed I.
        • Welch N.T.
        • Parsons S.L.
        Gastrointestinal stromal tumours (GIST): 17 years experience from Mid Trent Region (United Kingdom).
        Eur J Surg Oncol. 2007; 34: 445-449
        • Lin J.
        • Huang C.
        • Zheng C.
        • et al.
        Laparoscopic versus open gastric resection for larger than 5 cm primary gastric gastrointestinal stromal tumors (GIST): a size-matched comparison.
        Surg Endosc. 2014; 28: 2577-2583
        • Masoni L.
        • Gentili I.
        • Maglio R.
        • et al.
        Laparoscopic resection of large gastric GISTs: feasibility and long-term results.
        Surg Endosc. 2014; 28: 2905-2910
        • Chen K.
        • Zhou Y.C.
        • Mou Y.P.
        • et al.
        Systematic review and meta-analysis of safety and efficacy of laparoscopic resection for gastrointestinal stromal tumors of the stomach.
        Surg Endosc. 2015; 29: 355-367
        • Hu J.
        • Or B.H.
        • Hu K.
        • et al.
        Comparison of the post-operative outcomes and survival of laparoscopic versus open resections for gastric gastrointestinal stromal tumors: a multi-center prospective cohort study.
        Int J Surg. 2016; 33: 65-71
        • Hsiao C.Y.
        • Yang C.Y.
        • Lai I.R.
        • et al.
        Laparoscopic resection for large gastric gastrointestinal stromal tumor (GIST): intermediate follow-up results.
        Surg Endosc. 2015; 29: 868-873
        • Karakousis G.C.
        • Singer S.
        • Zheng J.
        • et al.
        Laparoscopic versus open gastric resections for primary gastrointestinal stromal tumors (GISTs): a size-matched comparison.
        Ann Surg Oncol. 2011; 18: 1599-1605
        • Qiu G.
        • Wang J.
        • Che X.
        • et al.
        Laparoscopic versus open resection of gastric gastrointestinal stromal tumors larger than 5 cm: a single-center, retrospective study.
        Surg Innov. 2017; 24: 582-589
        • Wang X.
        • Wang P.
        • Su H.
        • et al.
        Laparoscopic resection of intestinal stromal tumors with transrectal extract specimen: a case report.
        Medicine (Baltimore). 2019; 98e16377
        • Somu K.
        • Dashore A.R.
        • Shah A.R.
        • et al.
        Laparoscopic excision of large lower rectal gastrointestinal stromal tumour (GIST): a case report.
        J Minim Access Surg. 2016; 12: 283-285