Abstract
Background
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.
Methods
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.
Results
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).
Conclusion
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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Laparoscopic resection of benign stromal tumor of the stomach.J Laparoendosc Surg. 1992; 2: 331-334
- 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
- NCCN guidelines insights: soft tissue sarcoma, version 1.2021.J Natl Compr Canc Netw. 2020; 18: 1604-1612
- 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
- Laparoscopic management of gastric gastrointestinal stromal tumors: a retrospective 10-year single-center experience.World J Gastroenterol. 2017; 23: 3522-3529
- 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
- Laparoscopic wedge resection for suspected large (≥5 cm) gastric gastrointestinal stromal tumors.Surg Endosc. 2017; 31: 2271-2279
- Risk stratification of patients diagnosed with gastrointestinal stromal tumor.Human Pathol. 2008; 39: 1411-1419
- 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
- Gastrointestinal stromal tumours (GIST): 17 years experience from Mid Trent Region (United Kingdom).Eur J Surg Oncol. 2007; 34: 445-449
- 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
- Laparoscopic resection of large gastric GISTs: feasibility and long-term results.Surg Endosc. 2014; 28: 2905-2910
- 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
- 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
- Laparoscopic resection for large gastric gastrointestinal stromal tumor (GIST): intermediate follow-up results.Surg Endosc. 2015; 29: 868-873
- Laparoscopic versus open gastric resections for primary gastrointestinal stromal tumors (GISTs): a size-matched comparison.Ann Surg Oncol. 2011; 18: 1599-1605
- Laparoscopic versus open resection of gastric gastrointestinal stromal tumors larger than 5 cm: a single-center, retrospective study.Surg Innov. 2017; 24: 582-589
- Laparoscopic resection of intestinal stromal tumors with transrectal extract specimen: a case report.Medicine (Baltimore). 2019; 98e16377
- Laparoscopic excision of large lower rectal gastrointestinal stromal tumour (GIST): a case report.J Minim Access Surg. 2016; 12: 283-285
Article info
Publication history
Published online: July 19, 2022
Accepted:
April 29,
2022
Footnotes
Tao Wang, Zhen Xiong, and Yongzhou Huang have contributed equally to this work.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
