Kotaro Wakamatsu

Feasibility of Laparoscopic Resection of Gastrointestinal Stromal Tumor of the Stomach

BACKGROUND Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Complete surgical resection of localized GISTs is the only chance of cure for patients. Laparoscopic resections (LAP) have been widely accepted as a reasonable approach to treat gastric GISTs. The current study compares operative outcomes of laparoscopic and open resection of gastric GISTs. MATERIALS AND METHODS We retrospectively reviewed patients with primary gastric GISTs who underwent surgical resection between 2003 and 2015. RESULTS Of a total of 89 patients, 24 (27%) patients underwent open resection (OPEN), and 65 (73%) underwent LAP. LAP or OPEN did not differ with respect to gender, body mass index, and age. Median blood loss was significantly lower in LAP than in OPEN resection (32.5 mL versus 100 mL, P < .01). Both tumor location and median operative time were comparable between LAP and OPEN (108 versus 108 min, P = .93). Median tumor size in OPEN was significantly larger than LAP tumors (6.5 versus 3.8 cm, P < .01). LAP resection yielded a shorter hospital stay (3.0 versus 6.0 days P < .01) and lower 30-day readmission rate (17% versus 0%; P < .01). Complication rates were 9% after LAP and 12% after OPEN (P = .652). Two patients in each group died during the study period. Kaplan-Meier analysis for overall survival showed no significant difference between LAP and OPEN (P = .23). CONCLUSIONS LAP of gastric GISTs resulted in similar operative time and survival rate, but shorter hospital stay compared with open resection. Consequently, whenever possible, the laparoscopic approach should be preferably used for treatment of gastric GISTs. However, advanced tumor stage might dictate the need for open procedure with expected worse results.