Long-Term Outcomes and Recurrence Patterns in Upper Gastrointestinal Tract Gastrointestinal Stromal Tumours (GISTs) Treated by Minimally Invasive Surgery

Abstract

Background/Aims: Gastrointestinal stromal tumours are the most frequently occurring sarcoma of the gastrointestinal tract. Current treatment involves complete resection although the surgical or pathological margin required remains unclear. In this study we aimed to examine the risk of local and distant recurrence following laparoscopic resection. Methods: From a prospective tumour database, we identified and risk stratified primary non-metastatic tumours treated by laparoscopic resection from 2002-2012. Local technique involves allowing a 1 cm margin for resection. We then identified all cases of tumour recurrence and tumour related death in order to calculate overall survival, freedom from GIST recurrence and disease-specific survival respectively. Results: 90 patients were identified with a median follow-up of 3.9 years (range 1 week to 12.3 years). Five-year freedom from GIST recurrence and disease-specific survival rates in the high-risk group stood at 0.63 and 0.90. In the moderate-risk group these figures stood at 0.61 and 0.80 respectively. The low- and very-low-risk groups had a 10-year recurrence-free survival of 100% with no incidences of tumour-related recurrence. There were no local recurrences seen in any group at up to 10 years. Conclusion: The low recurrence rate suggests that these tumours can safely be treated laparoscopically with an R0 resection using a macroscopic surgical margin of 10 mm. Disease-specific survival was high. This may reflect earlier detection and the use of adjuvant imatinib.

State of the Art in the Treatment of Gastrointestinal Stromal Tumors

“…The feasibility of laparoscopic surgery for GISTs has been demonstrated in numerous series [43,44,45,46]. 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].…”