Laparoscopic versus open resection for gastric gastrointestinal stromal tumors: an updated systematic review and meta-analysis

Abstract

BackgroundIn past decades, laparoscopic surgery has been introduced for the treatment of gastrointestinal stromal tumors (GISTs). Recently, additional studies comparing laparoscopic versus open surgery for gastric GISTs have been published, and an updated meta-analysis of this subject is necessary.MethodsA systematic search was conducted in PubMed, Embase, Cochrane Library, and Web of Science. Comparative studies of laparoscopic and open surgery for gastric GISTs published before June 2014 were identified from databases. The Newcastle-Ottawa Quality Assessment Scale was used to perform quality assessment and original data were extracted. The statistical software STATA (version 12.0) was used for the meta-analysis.ResultsFinally, 22 studies, including a total of 1,166 cases, meet the inclusion criteria for meta-analysis. The operation time was similar between laparoscopic and open surgery. Compared to open surgery, laparoscopic resection was associated withless blood loss (WMD = -58.91 ml; 95% CI, -84.60 to -33.22 ml; P <0.01); earlier time to flatus (WMD = -1.31 d; 95% CI, -1.56 to -1.06, P <0.01) and oral diet (WMD = -1.75 d; 95% CI, -2.12 to -1.39; P <0.01); shorter hospital stay (WMD = -3.68 d; 95% CI, -4.47 to -2.88; P <0.01); and decreased overall complications (relative risk = 0.57; 95% CI, 0.37 to 0.89; P = 0.01). For long-term outcomes, there were no significant differences between two surgical procedures on recurrence.ConclusionLaparoscopic surgery for gastric GISTs is acceptable for selective patients with better short-term outcomes compared with open surgery. The long-term survival situation of patients mainly depends on the nature of tumor itself, and laparoscopic surgery was not associated with worse oncological outcomes.

Laparoscopic Versus Open Surgery for Gastric Gastrointestinal Stromal Tumors

“…Metaanalyses of comparative retrospective series suggested that the laparoscopic approach be proposed for smaller-diameter tumors, which yielded a similar operation time and favored a laparoscopic approach with its decreased intraoperative blood loss, and earlier recovery including time to first flatus, time to oral feeding, and decreased length of stay. [6][7][8][9][10][11] Conflicting data were reported regarding postoperative morbidity and oncologic results that were either similar or even better in the laparoscopic group, with a marginal impact on medical complications and a similar risk of surgical and grade III-IV complications. [6][7][8][9][10][11] From a methodological perspective, a meta-analysis of nonrandomized cohorts with no allocation concealment carries a potential risk of overstating the intervention effect by 30%-41%.…”

“…[6][7][8][9][10][11] Conflicting data were reported regarding postoperative morbidity and oncologic results that were either similar or even better in the laparoscopic group, with a marginal impact on medical complications and a similar risk of surgical and grade III-IV complications. [6][7][8][9][10][11] From a methodological perspective, a meta-analysis of nonrandomized cohorts with no allocation concealment carries a potential risk of overstating the intervention effect by 30%-41%. 18 In addition to the problem of the tumor size that clearly influences both the surgical technique and prognosis, most studies were not designed for oncologic purposes with missing or inconsistent data regarding the mitotic index or TKI administration and a limited follow-up.…”

“…Postoperative and oncologic results were either similar or even better in the laparoscopic group. [6][7][8][9][10][11] The perceived advantages or equivalence of the laparoscopic approach compared with the open approach may therefore be a result of this size selection bias or may be surrogates for less extensive resections.…”

State of the Art in the Treatment of Gastrointestinal Stromal Tumors

“…In a recent retrospective analysis of patients treated by laparoscopic resection of GISTs between 2002 and 2012, the 5-year recurrence-free survival was 63% in high-risk patients whereas it was 100% at 10 years in the low- and very-low-risk groups, indicating that laparoscopic surgery may be performed with similar results as open resection [47]. A recent meta-analysis of 22 studies comparing laparoscopic versus open surgery for GISTs including 1,166 patients demonstrated improved short-term results (intraoperative blood loss, onset of gastrointestinal motility, time to oral intake, hospital stay and overall complications) in the laparoscopic group [48]. However, one of the major pitfalls of surgery for GISTs is the risk of intraoperative tumor rupture, conferring a recurrence rate of almost 100% [49].…”

Gastrointestinal Stromal Tumors (GISTs): Single Center Experience Observed in a Small Series of Cases

“…The third one, comprising 12 articles and 644 patients concludes that laparoscopic surgery was associated with a reduction in intraoperative blood loss, earlier resumption of oral intake and shorter duration of hospital stay over the short-term, and with a significantly lower rate of overall recurrence, metastatic and local recurrence in the long-term compared to open surgery (Ohtani et al, 2013). The fourth one, of 22 studies including 1,166 patients concludes that laparoscopic surgery for gastric GISTs is acceptable for selective patients (Chen et al, 2014). Lastly, one of 19 studies and 1,060 cases concludes that laparoscopic approach had better results in terms of blood loss, postoperative morbidity (POM) and recovery .…”