Laparoscopic versus open resection of gastrointestinal stromal tumors of the stomach

Vogelaere, Kristel De; Hoorens, Anne; Haentjens, Patrick; Delvaux, Georges

doi:10.1007/s00464-012-2622-8

Cited by 81 publications

(40 citation statements)

References 23 publications

(29 reference statements)

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“…Our results show that only 2 (0.72%) of the patients with tumors <3.5 cm have a high mitotic index consistent, further validate the above points. Compared with open surgery, laparoscopic resection of gastric stromal tumors has been shown to be feasible, safe, and has an excellent incidence of complications, [21, 22] endoscopic resection, a new technique for the treatment of gastric GIST, represents a less invasive alternative to surgical procedures. Endoscopic resection can be safely performed by experienced endoscopic specialists, and overall resection is preferable to local resection to accurately assess the adequacy of treatment.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic versus laparoscopic resection of gastric gastrointestinal stromal tumors: a multicenter study

et al. 2016

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Despite endoscopic resection has been performed to treat gastric gastrointestinal stromal tumor (GISTs). However, the safety and long-term outcomes remains controversial. This study aims to compare the safety and surgical outcomes of endoscopic versus laparoscopic resection of gastric GISTs. A total of 335 patients that were pathologically confirmed with gastric GISTs (tumor size ≤ 3.5 cm) were surgically treated with endoscopic resection (endoscopic group) or laparoscopic resection (laparoscopic group) in three institutions from March 1, 2011 to October 1 2014. These demographics, tumor characteristics, and outcomes were retrospectively analyzed for identification of outcomes and feasibility of endoscopic or laparoscopic resection. Of 335 patients, 262 and 73 patients underwent endoscopic and laparoscopic resection, respectively. The average tumor size was 1.33±0.78 cm in the endoscopic group and 1.97±0.93 cm in the laparoscopic group. The average operating time was 62.40±36.94 min in the endoscopic group and 112.81±55.69 cm in the laparoscopic group. Days of realimentation was 2.76±1.67 in the endoscopic group and 4.89±2.03 in the laparoscopic group. The average cost was $ 3246.01±1017.61 in the endoscopic group and $ 4884.81±1339.51 in the laparoscopic group. There was no postoperative mortality. Endoscopic resection for gastric GISTs is safe and feasible in tumors ≤ 3.5 cm. Because endoscopic resection showed good results with lower operating time, realimentation days, length of hospital stay and mean total cost, it is a minimally invasive and safe alternative approach which can achieve fast recovery and satisfactory outcomes for appropriately selected patients with gastric GISTs.

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Section: Discussionmentioning

confidence: 99%

Endoscopic versus laparoscopic resection of gastric gastrointestinal stromal tumors: a multicenter study

et al. 2016

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“…In addition, we also observed that the common sites of postoperative recurrence of GISTs included liver metastasis, peritoneal metastasis and local recurrence. Most cases of recurrence or metastasis had a trend toward higher-risk profiles and no port metastasis was identified, which suggests tumor recurrence is not clearly related to the surgical approach [21,22,24,26,27,29,31,36,39]. …”

Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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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.

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“…Some series reported superiority of laparoscopic wedge resection for GIST over open surgery by showing fast oral intake, less pain, less inflammatory lab results, less blood loss, or shorter hospital stay lengths 67-69. Long-term results in terms of recurrence and survival rateswere also comparable to open surgery 70-72…”

Section: Indication For Laparoscopic Surgerymentioning

confidence: 99%

Surgical Treatment of Gastric Gastrointestinal Stromal Tumor

Suh

Yang

2013

J Gastric Cancer

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Gastrointestinal stromal tumor is the most common mesenchymal tumor in the gastrointestinal tract and is most frequently developed in the stomach in the form of submucosal tumor. The incidence of gastric gastrointestinal stromal tumor is estimated to be as high as 25% of the population when all small and asymptomatic tumors are included. Because gastric gastrointestinal stromal tumor is not completely distinguished from other submucosal tumors, a surgical excisional biopsy is recommended for tumors >2 cm. The surgical principles of gastrointestinal stromal tumor are composed of an R0 resection with a normal mucosa margin, no systemic lymph node dissection, and avoidance of perforation, which results in peritoneal seeding even in cases with otherwise low risk profiles. Laparoscopic surgery has been indicated for gastrointestinal stromal tumors <5 cm, and the indication for laparoscopic surgery is expanded to larger tumors if the above mentioned surgical principles can be maintained. A simple exogastric resection and various transgastric resection techniques are used for gastrointestinal stromal tumors in favorable locations (the fundus, body, greater curvature side). For a lesion at the gastroesophageal junction in the posterior wall of the stomach, enucleation techniques have been tried preserve the organ's function. Those methods have a theoretical risk of seeding a ruptured tumor, but this risk has not been evaluated by well-designed clinical trials. While some clinical trials are still on-going, neoadjuvant imatinib is suggested when marginally unresectable or multiorgan resection is anticipated to reduce the extent of surgery and the chance of incomplete resection, rupture or bleeding.

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Laparoscopic versus open resection of gastrointestinal stromal tumors of the stomach

Abstract: Compared to open resection, laparoscopic resection of gastric stromal tumors is associated with a shorter operation time, a shorter hospital stay, and a lower recurrence rate.

Cited by 81 publications

References 23 publications

Endoscopic versus laparoscopic resection of gastric gastrointestinal stromal tumors: a multicenter study

Endoscopic versus laparoscopic resection of gastric gastrointestinal stromal tumors: a multicenter study

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

Surgical Treatment of Gastric Gastrointestinal Stromal Tumor

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