Current evidence on laparoscopic vs. open resection for gastric stromal tumours (Review)

Abstract

Although the use of laparoscopic surgery is increasing, controversy still surrounds its application for malignant conditions. Gastrointestinal stromal tumours (GISTs) are less demanding in terms of lymphadenectomy, meaning that laparoscopic resection might have a more defined benefit when compared with open resection. To the best of our knowledge, no randomized study exists that compares the laparoscopic and open resection of GISTs. The current study aimed to examine the relevant literature by means of a systematic review. A systematic literature search was performed individually by two authors, in which three independent databases were searched using specific search-terms. Titles, abstracts and full texts were screened, as well as references to relevant articles, in order to comprise a comprehensive list of studies. Data were extracted using a detailed pre-agreed spreadsheet. Studies were evaluated according to the modified MINORS criteria. A total of 10 studies were included in the present review, yielding a total of 14 entries. The majority of studies reported significantly improved perioperative outcomes for the laparoscopic approach, including improved duration of operation, blood loss and length of hospital stay. Only four studies reported long-term outcomes and findings that were controversial, with some studies detecting no statistically significant differences, one reporting improved and one reporting worse disease-free and overall survival for the laparoscopic group. Three studies were deemed to be good quality, two of which had not reported significantly different long-term outcomes, while the third had reported significantly improved outcomes in the open resection group. While there is a clear benefit for performing laparoscopic surgery in patients with GIST with regards to perioperative outcomes, when it comes to long-term oncological outcomes, uncertainty over its application remains. The lack of randomized trials, as well as the poor reporting of retrospective studies, limits the amount of evidence that is currently available. Laparoscopic surgery for GIST is certainly safe, feasible and likely cost-effective; however, further studies are required to inform on whether this technique is superior to open resection.

The Diagnosis of Small Gastrointestinal Subepithelial Lesions by Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy

“…In previous studies, laparoscopic resection for GIST was reported to be safe, feasible, cost-effective, and superior to open resection [84][85][86]. Additionally, it is reported that several treatment methods using ESD techniques, such as submucosal tunneling endoscopic resection (STER), endoscopic full-thickness resection, laparoscopic endoscopic cooperative surgery (LECS), and non-exposed endoscopic wall-inversion surgery (NEWS), and a combined laparoscopic and endoscopic approach for neoplasia with a non-exposure technique (CLEAN-NET) have shown good clinical outcomes [87][88][89][90].…”

Inflammation and nutritional status indicators as prognostic indicators for patients with locally advanced gastrointestinal stromal tumors treated with neoadjuvant imatinib

“…Currently, the preferred treatment for GIST patients is surgical resection, with the goals of obtaining R0 margins, avoiding intraoperative tumour rupture and maximising preservation of organ function [ 3 , 4 ]. Nevertheless, a growing number of studies have found that direct surgical resection is difficult for patients with specific sites (oesophagogastric junction, low rectum, duodenum) and large tumour diameters [ 5 , 6 ]. Recently, imatinib, a small molecule tyrosine kinase inhibitor (TKI), has been widely used as an adjuvant therapy for GIST patients after surgery as it can inhibit cell growth and promote apoptosis by blocking tyrosine kinase [ 7 , 8 ].…”