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Laparoscopic Versus Open Gastric Resections for Primary Gastrointestinal Stromal Tumors (GISTs): A Size-Matched Comparison

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Laparoscopic resection of gastric GISTs appears technically feasible and associated with favorable outcomes. Tumor size however frequently plays a role in surgical approach with larger tumors tending toward laparotomy, raising concern that favorable outcomes reported for the laparoscopic approach may reflect this selection bias.

Materials and Methods

From a prospectively collected sarcoma database, 155 primary gastric GIST resections were identified (1998–2009); 40 patients underwent successful laparoscopic resection for non-GE junction GIST and were randomly matched (1:1) by tumor size (±2.0 cm) to patients with open resection. Clinical and pathologic variables and surgical outcomes were associated with surgery type using conditional logistic regression analyses.

Results

The two surgical approaches were comparable for clinical and pathologic variables. Median operating room (OR) time was similar, although median length of stay postsurgery was lower in the laparoscopic versus open group (4 vs. 7 days, P = 0.002), as was estimated blood loss (EBL) (25 vs. 100 ml, P = 0.006). There was no operative mortality, and 30-day morbidity was similar. Oncologic outcomes were also similar with no positive microscopic margins, and 1 recurrence in each group with a median follow-up of 34 months. There were 13 conversions overall, 5 secondary to tumor location at the GE junction or lesser curve.

Conclusions

When matched for tumor size, laparoscopic resection of primary gastric GISTs ≤8 cm results in shorter hospital stays with similar OR time while maintaining sound oncologic outcomes compared with open resection.

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References

  1. Miettinen M, Lasota J. Gastrointestinal stromal tumors–definition, clinical, histological, immunohistochemical, and molecular genetic features and differential diagnosis. Virchows Arch. 2001;438:1–12.

    Article  PubMed  CAS  Google Scholar 

  2. Hirota S, Isozaki K, Moriyama Y, Hashimoto K, Nishida T, Ishiguro S, et al. Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Science. 1998;279:577–80.

    Article  PubMed  CAS  Google Scholar 

  3. Joensuu H, Dimitrijevic S. Tyrosine kinase inhibitor imatinib (STI571) as an anticancer agent for solid tumours. Ann Med. 2001;33:451–5.

    Article  PubMed  CAS  Google Scholar 

  4. Woodall CE, 3rd, Brock GN, Fan J,Byam JA, Scoggins CR, McMasters KM, et al. An evaluation of 2537 gastrointestinal stromal tumors for a proposed clinical staging system. Arch Surg. 2009;144:670–8.

    Article  PubMed  Google Scholar 

  5. DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg. 2000;231:51–8.

    Article  PubMed  CAS  Google Scholar 

  6. Novitsky YW, Kercher KW, Sing RF, Heniford BT. Long-term outcomes of laparoscopic resection of gastric gastrointestinal stromal tumors. Ann Surg. 2006;243:738–45 (discussion 745–7).

    Google Scholar 

  7. Sexton JA, Pierce RA, Halpin VJ, Eagon JC, Hawkins WG, Linehan DC, et al. Laparoscopic gastric resection for gastrointestinal stromal tumors. Surg Endosc. 2008;22:2583–7.

    Article  PubMed  Google Scholar 

  8. Otani Y, Furukawa T, Yoshida M, Saikawa Y, Wada N, Ueda M, et al. Operative indications for relatively small (2–5 cm) gastrointestinal stromal tumor of the stomach based on analysis of 60 operated cases. Surgery. 2006;139:484–92.

    Article  PubMed  Google Scholar 

  9. Sasaki A, Koeda K, Obuchi T, Nakajima J, Nishizuka S, Terashima M, et al. Tailored laparoscopic resection for suspected gastric gastrointestinal stromal tumors. Surgery. 2010;147:516–20.

    Article  PubMed  Google Scholar 

  10. Sokolich J, Galanopoulos C, Dunn E, Linder JD, Jeyarajah DR. Expanding the indications for laparoscopic gastric resection for gastrointestinal stromal tumors. JSLS. 2009;13:165–9.

    PubMed  Google Scholar 

  11. Catena F, Di Battista M, Fusaroli P, Ansaloni L, Di Scioscio V, Santini D, et al. Laparoscopic treatment of gastric GIST: report of 21 cases and literature’s review. J Gastrointest Surg. 2008;12:561–8.

    Article  PubMed  Google Scholar 

  12. Privette A, McCahill L, Borrazzo E, Single RM, Zubarik R. Laparoscopic approaches to resection of suspected gastric gastrointestinal stromal tumors based on tumor location. Surg Endosc. 2008;22:487–94.

    Article  PubMed  CAS  Google Scholar 

  13. Choi SM, Kim MC, Jung GJ, Kim HH, Kwon HC, Choi SR, et al. Laparoscopic wedge resection for gastric GIST: long-term follow-up results. Eur J Surg Oncol. 2007;33:444–7.

    Article  PubMed  Google Scholar 

  14. Demetri GD, Benjamin RS, Blanke CD, Blay JY, Casali P, Choi H, et al. NCCN Task Force report: management of patients with gastrointestinal stromal tumor (GIST)—update of the NCCN clinical practice guidelines. J Natl Compr Canc Netw. 2007;Suppl 2:S1–29 (quiz S30).

    Google Scholar 

  15. Matthews BD, Walsh RM, Kercher KW, Sing RF, Pratt BL, Answini GA, et al. Laparoscopic vs open resection of gastric stromal tumors. Surg Endosc. 2002;16:803–7.

    Article  PubMed  CAS  Google Scholar 

  16. Nicholson ML, Kaushik M, Lewis GR, Brook NR, Bagul A, Kay MD, et al. Randomized clinical trial of laparoscopic versus open donor nephrectomy. Br J Surg. 2010;97:21–8.

    Article  PubMed  CAS  Google Scholar 

  17. Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, et al. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg. 2005;241:232–7.

    Article  PubMed  Google Scholar 

  18. Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005;6:477–84.

    Article  PubMed  Google Scholar 

  19. Hindmarsh A, Koo B, Lewis MP, Rhodes M. Laparoscopic resection of gastric gastrointestinal stromal tumors. Surg Endosc. 2005;19:1109–12.

    Article  PubMed  CAS  Google Scholar 

  20. Basu S, Balaji S, Bennett DH, Davies N. Gastrointestinal stromal tumors (GIST) and laparoscopic resection. Surg Endosc. 2007;21:1685–9.

    Article  PubMed  Google Scholar 

  21. Nguyen SQ, Divino CM, Wang JL, Dikman SH. Laparoscopic management of gastrointestinal stromal tumors. Surg Endosc. 2006;20:713–6.

    Article  PubMed  CAS  Google Scholar 

  22. Tagaya N, Mikami H, Kogure H, Kubota K, Hosoya Y, Nagai H. Laparoscopic intragastric stapled resection of gastric submucosal tumors located near the esophagogastric junction. Surg Endosc. 2002;16:177–9.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Giorgos C. Karakousis MD, Samuel Singer MD, Daniel Coit MD, Ronald P. DeMatteo MD & Vivian E. Strong MD

  2. Department of Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Junting Zheng MS & Mithat Gonen PhD

Authors
  1. Giorgos C. Karakousis MD
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  2. Samuel Singer MD
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  3. Junting Zheng MS
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  4. Mithat Gonen PhD
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  5. Daniel Coit MD
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  6. Ronald P. DeMatteo MD
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  7. Vivian E. Strong MD
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Correspondence to Vivian E. Strong MD.

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Karakousis, G.C., Singer, S., Zheng, J. et al. Laparoscopic Versus Open Gastric Resections for Primary Gastrointestinal Stromal Tumors (GISTs): A Size-Matched Comparison. Ann Surg Oncol 18, 1599–1605 (2011). https://doi.org/10.1245/s10434-010-1517-y

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  • DOI: https://doi.org/10.1245/s10434-010-1517-y

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