Laparoscopic versus open resection of gastrointestinal stromal tumors: survival outcomes from the NCDB

Inaba, Colette S.; Dosch, Austin R.; Koh, Christina Y.; Sujatha-Bhaskar, Sarath; Pejcinovska, Marija; Smith, Brian R.; Nguyen, Ninh T.

doi:10.1007/s00464-018-6393-8

Cited by 16 publications

(15 citation statements)

References 26 publications

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“…The laparoscopic resection of GISTs has been demonstrated to be feasible and safe. [16][17][18] In the Chinese consensus guideline, 5 laparoscopic surgery is recommended for tumors located at the greater curvature of the stomach or with diameter ≤ 5cm of the anterior wall of the gastric fundus. Our data showed that it resulted in a shorter hospital stay (6.09±0.465 vs 7.79±0.273days; p=0.002) and a higher hospital cost Due to the development of endoscopic resection and the biological behavior of GISTs (no lymph node metastasis), currently gastric GISTs can be resected using the endoscopy.…”

Section: Discussionmentioning

confidence: 99%

<p>Endoscopic or Surgical Resection for Patients with 2–5cm Gastric Gastrointestinal Stromal Tumors: A Single-Center 12-Year Experience from China</p>

Lei¹,

Tan²,

Liu³

et al. 2020

CMAR

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The surgical or endoscopic resection is the current treatment modality for 2-5 cm gastric gastrointestinal stromal tumors (GISTs). However, evidence is lacking as to which treatment modality is better. Our objective is to provide a new reference for the standardization of the treatment of 2-5 cm gastric GISTs. Patients and Methods: A retrospective study was conducted on 177 patients who underwent resection for 2-5cm gastric GISTs between January 2007 and July 2019 at Xiangya Hospital of Central South University. The cases were divided into surgical group (n=118) and endoscopic group (n=59). The clinical data, pathological and genetic characteristics, shortand long-term outcomes were compared. Results: Symptoms showed more obvious in the surgical group including abdominal pain and bleeding. In the endoscopic group, tumor size was smaller (p<0.001), and risk classification was lower (p<0.001). Patients in the endoscopic group had shorter anal exhaust time (p<0.001) and lesser hospital cost (p<0.001). However, the incidence rate of complications (25.42 vs 4.20%; p<0.001) and reoperation (22.03 vs 0.00%; p<0.001) in the endoscopic group was relatively higher than these in the surgical group. There was no significant difference in recurrence-free survival or overall survival between two groups. Conclusion: Gastric GISTs of 2-5cm may be suitable to select laparoscopic surgery.

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Section: Discussionmentioning

confidence: 99%

<p>Endoscopic or Surgical Resection for Patients with 2–5cm Gastric Gastrointestinal Stromal Tumors: A Single-Center 12-Year Experience from China</p>

Lei¹,

Tan²,

Liu³

et al. 2020

CMAR

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“…For that, laparoscopy appears technically feasible and associated with a better outcome than open surgery. Inaba et al (14) showed in his study the feasibility and safety of laparoscopy for gastric GIST resection.…”

Section: Discussionmentioning

confidence: 99%

“…Tumor size can change the surgical approach. Inaba et al (14) and Lin et al (15) recommended laparotomy tending to be used to treat larger tumors.…”

Section: Discussionmentioning

confidence: 99%

An Unexpected Finding of Gastrointestinal Stromal Tumors During Laparoscopic Sleeve Gastrectomy; How to Deal? How Much Safety Margin Needed?

Sieda

Habeeb

2020

Int J Cancer Manag

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Background: There is an increasing incidence of coincidental gastric gastrointestinal stromal tumors (GIST) during a laparoscopic sleeve gastrectomy (LSG). Resection with negative margin R0 is the safest and most proper treatment. Objectives: The incidence of GIST in patients undergoing LSG and resection with a 1- to 2-cm safety margin was validated and analyzed. The primary endpoint is that can simultaneous excision be oncologically adequate or not? How much GIST is supposed to be far from a staple line? Methods: The present prospective study included 338 patients with body mass index (BMI) ≥ 35. All patients underwent LSG without known history or imaging reveal GIST. Resection was done with a safety margin of 1 to 2 cm away from the stapled margin and, then, sent for histopathology and immunohistochemically staining. Results: A total of 17 patients (5%) had coincidental GIST. The size was T1 in 88.2% of patients; 16 patients were staged as IA according to the American Joint Committee on Cancer (AJCC TNM). Safety margin was ≤ 1 cm for 3 patients to avoid incorporation in staple line and 14 patients (82.3%) had 2 cm safety margin. Resection margin in biopsy revealed positive resection margin R1 for 2 patients, whose safety margin was only 1 cm or less. A total of 15 patients had a negative margin (R0), whose safety margin was 2 cm. Conclusions: Any incidental GIST can be removed safely during LSG as long as it is far from the staple line with at least a 2-cm safety margin and negative resection margins without changing the procedure. Margins less than 1 cm are associated with adverse prognostic factors.

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“…Laparoscopy, which has been demonstrated to have a lower incidence of perioperative events and indistinctive long-term complications than traditional surgery, has become the main trend. 6 Serendipitously, because asymptomatic GISTs are located in feasible sites, resection by endoscopy has also gained acceptance, as this…”

Section: Introductionmentioning

confidence: 99%

Open and minimally invasive surgery for gastrointestinal stromal tumours: a systematic review and network meta-analysis protocol

Cai

Liu

et al. 2022

BMJ Open

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IntroductionGastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the digestive system, and complete resection is the only way to provide a radical cure for resectable GISTs. Open surgery and minimally invasive approaches, including laparoscopy, robotic surgery and endoscopy, consist of the mainstream GIST resection. However, there is still a lack of evidence regarding which surgical outcomes and long-term prognosis would be better. Thus, we are planning to conduct a network meta-analysis and systematic review aiming to determine the comparative effectiveness among laparotomy, laparoscopy, endoscopy, robotic surgery, and laparoscopic and endoscopic cooperative surgery in GISTs.Method and analysisPubMed, EMBASE, the Cochrane Library and Web of Science will be searched for published studies to identify the proper literature comparing open resection, laparoscopy, endoscopy, robotic surgery, and laparoscopic and endoscopic cooperative surgery for resecting GISTs from inception to February 2021. Randomised controlled trials (RCTs) and non-randomised studies comparing at least two different interventions for GIST resection will be included. RCTs and non-randomised studies will be synthesised and analysed separately. Bayesian network meta-analysis will be performed to compare the surgical outcomes and long-term prognosis among the resection methods above. The included studies will be divided into several subgroups according to tumour location and size for further analysis. Sensitivity analysis will be performed to identify and explain heterogeneity to make our results robust. Meta-regression will serve as a supplementary method if data are available. The quality of evidence will be evaluated by the Grading of Recommendations, Assessment, Development and Evaluation.Ethics and disseminationNo ethical approval is required for this network meta-analysis, as it is based on already published data. The findings of the review will be published in a peer-reviewed journal.PROSPERO registration numberCRD42021237892.

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Laparoscopic versus open resection of gastrointestinal stromal tumors: survival outcomes from the NCDB

Abstract: Laparoscopic and open GIST resection have comparable 90-day mortality with possible improved long-term survival with laparoscopy for early-stage disease. These findings support the use of laparoscopy as a viable and potentially more effective approach to GIST resection.

Cited by 16 publications

References 26 publications

<p>Endoscopic or Surgical Resection for Patients with 2–5cm Gastric Gastrointestinal Stromal Tumors: A Single-Center 12-Year Experience from China</p>

<p>Endoscopic or Surgical Resection for Patients with 2–5cm Gastric Gastrointestinal Stromal Tumors: A Single-Center 12-Year Experience from China</p>

An Unexpected Finding of Gastrointestinal Stromal Tumors During Laparoscopic Sleeve Gastrectomy; How to Deal? How Much Safety Margin Needed?

Open and minimally invasive surgery for gastrointestinal stromal tumours: a systematic review and network meta-analysis protocol

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