Laparoscopic versus open wedge resection for gastrointestinal stromal tumors of the stomach: a single-center 8-year retrospective cohort study of 156 patients with long-term follow-up

Abstract

BackgroundThe aim of this study was to compared laparoscopic (LWR) and open wedge resection (OWR) for the treatment of gastric gastrointestinal stromal tumors (GISTs).MethodsThe data of 156 consecutive GISTs patients underwent LWR or OWR between January 2006 and December 2013 were collected retrospectively. The surgical outcomes and the long-term survival rates were compared. Besides, a rapid systematic review and meta-analysis were conducted.ResultsClinicopathological characteristics of the patients were similar between the two groups. The LWR group was associated with less intraoperative blood loss (67.3 vs. 142.7 ml, P < 0.001), earlier postoperative flatus (2.3 vs. 3.2 days, P < 0.001), earlier oral intake (3.2 vs. 4.1 days, P < 0.001) and shorter postoperative hospital stay (6.0 vs. 8.0 days, P = 0.001). The incidence of postoperative complications was lower in LWR group but did not reach statistical significance (4/90, 4.4% vs. 8/66, 12.1%, P = 0.12). No significant difference was observed in 3-year relapse-free survival rate between the two groups (98.6% vs. 96.4%, P > 0.05). The meta-analysis revealed similar results except less overall complications in the LWR group (RR = 0.49, 95% CI, 0.25 to 0.95, P = 0.04). And the recurrence risk was similar in two group (RR = 0.80, 95% CI, 0.28 to 2.27, P > 0.05).ConclusionsLWR is a technically and oncologically safe and feasible approach for gastric GISTs compared with OWR. Moreover, LWR appears to be a preferable choice with mini-invasive benefits.

Efficacy and complications of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors and exploration for influencing factors

“…In addition, open surgery results in large surgery trauma, delayed recovery, and serious postoperative complication. As reported, the overall complication rate including anastomotic hemorrhage, delayed gastric emptying, and abdominal abscess was as high as 12.1 % [21]. The open surgery-related complications adversely affect the patient's quality of life postoperatively.…”

Laparoscopic gastric wedge resection as the method of choice in the treatment of gastrointestinal stromal tumors: A case report

“…According to available data from the literature, about 40% of patients underwent laparoscopic surgery, and this fact reduced the postoperative morbid-ity. The reduction of the postoperative pain and blood loss, faster start of oral intake, and a better esthetic effect are some of the advantages of this minimally invasive technique [14,15]. Data from the literature showed no significant difference in the five-year survival percentage between laparoscopic wedge resection and open wedge resection treated GIST patients (93.7% for the first, and 95.5% for the second group) [16].…”

Minimally invasive surgery for gastric gastrointestinal stromal tumors

“…To date, several large case-control studies have reported on the outcomes of laparoscopic resection of gastric GIST in comparison with conventional open resection. Tables 1-3 summarizes the results from several of these large (n>50) case-control studies demonstrating that laparoscopic resection can be performed with a low conversion rate and was associated with superior perioperative outcomes such as shorter hospital stay, earlier oral intake, lower morbidity with similar oncological outcomes compared to the open approach (27)(28)(29)(30)(31)(32). Similarly, several systematic reviews and meta-analyses have demonstrated that laparoscopic resection was superior in perioperative outcomes compared to open surgery (33)(34)(35).…”