Laparoscopic Versus Open Surgery for Gastric Gastrointestinal Stromal Tumors

Piessen, Guillaume; Lefèvre, Jérémie H.; Cabau, Magalie; Duhamel, Alain; Behal, Hélène; Perniceni, Thierry; Mabrut, Jean‐Yves; Régimbeau, Jean-Marc; Bonvalot, Sylvie; Tiberio, Guido Alberto Massimo; Mathonnet, Muriel; Régenet, Nicolas; Guillaud, Antoine; Gléhen, Olivier; Mariani, Pascale; Denost, Quentin; Maggiori, Léon; Benhaïm, Léonor; Manceau, Gilles; Mutter, Didier; Bail, Jean‐Pierre; Meunier, Brigitte; Porcheron, J.; Mariette, C.; Brigand, Cécile

doi:10.1097/sla.0000000000001488

Cited by 56 publications

(28 citation statements)

References 24 publications

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“…No significant difference in postoperative complications was observed between the LR and OR groups in the present study, which is consistent with the findings of other studies[31,32]. Some other studies have shown that LR of gGISTs may reduce postoperative complications[33]. The Clavien-Dindo classification is a commonly used evaluation system for postoperative complications[17].…”

Section: Discussionsupporting

confidence: 91%

“…Some other studies have obtained different results. A European multicenter study of 61 centers involving 1413 patients with gGISTs revealed that the 5-year DFS rate in the LR group was significantly higher than that in the OR group[33]. In another meta-analysis, the recurrence rate in the OR group was significantly higher than that in the LR group.…”

Section: Discussionmentioning

confidence: 99%

“…With a better understanding of the molecular pathogenesis of GISTs and the application of tyrosine kinase inhibitors, the prognosis of patients with GISTs has been greatly improved[2]. Some studies have shown 5-year DFS rates of > 90% after adjuvant therapy[33,36]. Recent studies have found that the main prognostic factors of GISTs are the pathological features, including tumor size, mitotic count, tumor location, and intraoperative rupture[10].…”

Section: Discussionmentioning

confidence: 99%

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Comparison of short- and long-term outcomes of laparoscopic vs open resection for gastric gastrointestinal stromal tumors

Ye¹,

Kang²,

Yu³

et al. 2017

WJG

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AIMTo compare the short- and long-term outcomes of laparoscopic (LR) vs open resection (OR) for gastric gastrointestinal stromal tumors (gGISTs).METHODSIn total, 301 consecutive patients undergoing LR or OR for pathologically confirmed gGISTs from 2005 to 2014 were enrolled in this retrospective study. After exclusion of 77 patients, 224 eligible patients were enrolled (122 undergoing LR and 102 undergoing OR). The demographic, clinicopathologic, and survival data of all patients were collected. The intraoperative, postoperative, and long-term oncologic outcomes were compared between the LR and OR groups following the propensity score matching to balance the measured covariates between the two groups.RESULTSAfter 1:1 propensity score matching for the set of covariates including age, sex, body mass index, American Society of Anesthesiology score, tumor location, tumor size, surgical procedures, mitotic count, and risk stratification, 80 patients in each group were included in the final analysis. The baseline parameters of the two groups were comparable after matching. The LR group was significantly superior to the OR group with respect to the operative time, intraoperative blood loss, postoperative first flatus, time to oral intake, and postoperative hospital stay (P < 0.05). No differences in perioperative blood transfusion or the incidence of postoperative complications were observed between the two groups (P > 0.05). No significant difference was found in postoperative adjuvant therapy (P = 0.587). The mean follow-up time was 35.30 ± 26.02 (range, 4-102) mo in the LR group and 40.99 ± 25.07 (range, 4-122) mo in the OR group with no significant difference (P = 0.161). Survival analysis showed no significant difference in the disease-free survival time or overall survival time between the two groups (P > 0.05).CONCLUSIONLaparoscopic surgery for gGISTs is superior to open surgery with respect to intraoperative parameters and postoperative outcomes without compromising long-term oncological outcomes.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Comparison of short- and long-term outcomes of laparoscopic vs open resection for gastric gastrointestinal stromal tumors

Ye¹,

Kang²,

Yu³

et al. 2017

WJG

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“…Various clinical studies and meta-analysis have demonstrated that LAP for GISTs of the stomach had associated with lesser pain, shorter hospital stay, faster postoperative recovery, lower morbidity, and similar recurrence rates compared to open approach (OPEN). [4567] However, there is a paucity in the literature on the management and outcomes of laparoscopic small bowel GISTs resection due to relatively low incidence rate. [8] Therefore, the reliable short-term outcomes following LAP for small bowel GISTs are unknown.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic versus Open Resection of Small Bowel Gastrointestinal Stromal Tumors

Chen

Zhang

Liang

et al. 2017

Chinese Medical Journal

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Background:Laparoscopic resection (LAP) for small bowel gastrointestinal stromal tumors (GISTs) is not as common as for stomach. This study aimed to evaluate the safety and efficacy of LAP for small bowel GISTs with systematic review and meta-analysis.Methods:The Web of Science, Cochrane Library, Embase, and PubMed databases before December 2016 were comprehensively searched to retrieve comparative trials of LAP and conventional open resection (OPEN) for GISTs of small bowel with a relevance of review object. These researches reported intraoperative and postoperative clinical course (operation time, blood loss, time to first flatus and oral intake, hospital stay, morbidity, and mortality), oncologic outcomes, and long-term survival status.Results:Six studies involving 391 patients were identified. Compared to OPEN, LAP had associated with a shorter operation time (weighted mean difference [WMD] = −27.97 min, 95% confidence interval [CI]: −49.40–−6.54, P < 0.01); less intraoperative blood loss (WMD = −0.72 ml; 95% CI: −1.30–−0.13, P = 0.02); earlier time to flatus (WMD = −0.83 day; 95% CI: −1.44–−0.22, P < 0.01); earlier time to restart oral intake (WMD = −1.95 days; 95% CI: −3.31–−0.60, P < 0.01); shorter hospital stay (WMD = −3.00 days; 95% CI: −4.87–−1.13, P < 0.01); and a decrease in overall complications (risk ratio = 0.56, 95% CI: 0.33–0.97, P = 0.04). In addition, the tumor recurrence and long-term survival rate showed that there was no significant difference between the two groups of patients.Conclusions:LAP for small bowel GISTs is a safe and feasible procedure with shorter operation time, less blood loss, less overall complications, and quicker recovery. Besides, tumor recurrence and the long-term survival rate are similar to open approach. Because of the limitations of this study, methodologically high-quality studies are needed for certain appraisal.

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“…Complete resection, together with tumor-free margins and avoidance of tumor rupture, remain the only curative treatment option for resectable GISTs, because tumor rupture, either spontaneous or at surgery, is associated with a high risk of recurrence [3,4]. Unfortunately, approximately two thirds of patients with GIST will experience recurrence or metastasis during the course of their disease [5,6,7]. Tumor size and mitotic count are well-documented prognostic factors in resectable GISTs, but additional factors - particularly tumor rupture and tumor site - seem to modify the risk, as shown in the National Institutes of Health (NIH) consensus classification system based on large GIST cohorts [8].…”

Section: Introductionmentioning

confidence: 99%

Surgical Management in Patients with Gastrointestinal Stromal Tumors: A Single-Center Experience

et al. 2016

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Background: We have revisited prognostic outcomes and recurrence patterns in patients with gastrointestinal stromal tumors (GISTs) who underwent complete surgical resection at a single institution. Patients and Methods: Patients who underwent curative surgical treatment were divided into two groups: those with high-risk GISTs (high-risk group) and those with very low-, low-, and intermediate-risk GISTs (lower-risk group). Results: A total of 109 patients who underwent surgery as an initial treatment for GIST were studied. The overall 5- and 10-year survival rates after surgery were 90.3 and 71.1%, respectively. The 5-year survival rate in high-risk group patients was 88.1%, and their overall survival rate did not vary significantly from that of the lower-risk group (5-year survival rate, 91.3%). The recurrence rate in patients with high-risk GISTs gradually increased without reaching a plateau, with a cumulative rate of GIST recurrence of 26.4 and 48.9% at 5 and 10 years after surgical treatment, respectively. Conclusions: Our data suggest that the repeat surgical management in metastatic GIST is of clinical usefulness whatever the risk and improves survival.

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Laparoscopic Versus Open Surgery for Gastric Gastrointestinal Stromal Tumors

Abstract: Laparoscopic resection for gGISTs is associated with favorable short-term outcomes without compromising oncologic results.

Cited by 56 publications

References 24 publications

Comparison of short- and long-term outcomes of laparoscopic vs open resection for gastric gastrointestinal stromal tumors

Comparison of short- and long-term outcomes of laparoscopic vs open resection for gastric gastrointestinal stromal tumors

Laparoscopic versus Open Resection of Small Bowel Gastrointestinal Stromal Tumors

Surgical Management in Patients with Gastrointestinal Stromal Tumors: A Single-Center Experience

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