Zhen Xiong1, Wenze Wan1, Xiangyu Zeng1, Weizhen Liu1, Tao Wang1, Ruizhi Zhang1, Chengguo Li1, Wenchang Yang1, Peng Zhang2, Kaixiong Tao3. 1. Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, Hubei Province, China. 2. Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, Hubei Province, China. zhangpengwh@hust.edu.cn. 3. Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, Hubei Province, China. kaixiongtao@hust.edu.cn.
Abstract
BACKGROUND: Surgery is the first choice for the treatment of gastric gastrointestinal stromal tumors (GISTs). With the development of new instruments and techniques, the popularity of laparoscopic resection of GISTs has increased rapidly. Previous studies on the advantages of laparoscopic resection over open surgery are generally limited by methodology or data capacity. This study evaluated the efficacy of laparoscopic resection and open surgery in gastric GISTs using the propensity score matching (PSM) method. METHODS: Between January 2005 and December 2017, 1027 patients were diagnosed with primary GIST at our institution. Among them, 548 patients were enrolled in this study. Standard demographic and clinicopathological data were collected from our database. Selection bias was eliminated using the PSM methods. RESULTS: After PSM, 256 cases involved in the comparison (128 laparoscopic (LAP) vs. 128 open surgery (OPEN)) were randomly matched (1:1) by age, sex, body mass index, hypertension, diabetes, heart disease, year of surgery, tumor location, tumor size, mitotic rate, and treatment with adjuvant tyrosine kinase inhibitors. The LAP group was superior to the OPEN group in blood loss (χ2 = 6.048, P = 0.049), time to first flatus (49.41 ± 7.56 vs. 71.31 ± 4.87 h, P < 0.001), and hospital stay (10.21 ± 6.05 vs. 12.56 ± 5.43 days, P = 0.001). No significant differences were seen in either the relapse-free survival or overall survival between the LAP and OPEN groups. In tumors located in favorable locations, the LAP group showed less blood loss (P = 0.008) and less multivisceral resection (17.8% vs. 5.5%, P = 0.02). CONCLUSIONS: Laparoscopic resection for gastric GISTs is associated with improved surgical outcomes and postoperative courses and comparable oncological outcomes, regardless of favorable or unfavorable tumor location.
BACKGROUND: Surgery is the first choice for the treatment of gastric gastrointestinal stromal tumors (GISTs). With the development of new instruments and techniques, the popularity of laparoscopic resection of GISTs has increased rapidly. Previous studies on the advantages of laparoscopic resection over open surgery are generally limited by methodology or data capacity. This study evaluated the efficacy of laparoscopic resection and open surgery in gastric GISTs using the propensity score matching (PSM) method. METHODS: Between January 2005 and December 2017, 1027 patients were diagnosed with primary GIST at our institution. Among them, 548 patients were enrolled in this study. Standard demographic and clinicopathological data were collected from our database. Selection bias was eliminated using the PSM methods. RESULTS: After PSM, 256 cases involved in the comparison (128 laparoscopic (LAP) vs. 128 open surgery (OPEN)) were randomly matched (1:1) by age, sex, body mass index, hypertension, diabetes, heart disease, year of surgery, tumor location, tumor size, mitotic rate, and treatment with adjuvant tyrosine kinase inhibitors. The LAP group was superior to the OPEN group in blood loss (χ2 = 6.048, P = 0.049), time to first flatus (49.41 ± 7.56 vs. 71.31 ± 4.87 h, P < 0.001), and hospital stay (10.21 ± 6.05 vs. 12.56 ± 5.43 days, P = 0.001). No significant differences were seen in either the relapse-free survival or overall survival between the LAP and OPEN groups. In tumors located in favorable locations, the LAP group showed less blood loss (P = 0.008) and less multivisceral resection (17.8% vs. 5.5%, P = 0.02). CONCLUSIONS: Laparoscopic resection for gastric GISTs is associated with improved surgical outcomes and postoperative courses and comparable oncological outcomes, regardless of favorable or unfavorable tumor location.
Entities:
Keywords:
GISTs; Laparoscopic surgery; Open surgery; Propensity score matching
Authors: George D Demetri; Margaret von Mehren; Cristina R Antonescu; Ronald P DeMatteo; Kristen N Ganjoo; Robert G Maki; Peter W T Pisters; Chandrajit P Raut; Richard F Riedel; Scott Schuetze; Hema M Sundar; Jonathan C Trent; Jeffrey D Wayne Journal: J Natl Compr Canc Netw Date: 2010-04 Impact factor: 11.908