Skip to main content

Advertisement

SpringerLink
Log in

Laparoscopic versus open gastric resection for larger than 5 cm primary gastric gastrointestinal stromal tumors (GIST): a size-matched comparison

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Laparoscopic resection of gastric gastrointestinal stromal tumors (GISTs) appears technically feasible and associated with favorable outcomes. Tumor size plays an important role in surgical approach, with laparotomy tending to be used to treat larger tumors. This study evaluated the technical feasibility, safety, and oncologic efficacy of laparoscopic surgery for GISTs ≥5 cm in diameter.

Methods

One hundred forty patients who underwent resection of primary gastric GIST at our institution from January 2007 to December 2012 were identified. Twenty-three patients with tumor larger than 5 cm in diameter treated by laparoscopic resection and were randomly matched (1:1) by tumor size (±1 cm) to patients with open resection. Clinical and pathologic variables and surgical outcomes for each surgical type were identified and compared.

Results

There were no significant differences in clinicopathologic characteristics between the two groups. Laparoscopic group was superior to open group in operation time, blood loss, time to ground activities, time to first flatus, times to liquid diet, and postoperative stay (P < 0.05). Number of transfusions and time to semi-liquid diet, however, did not differ between groups. There was no operative mortality, and the postoperative complications were similar. Fifteen patients in the laparoscopic group and 17 patients in the open group received adjuvant treatment with imatinib. Recurrence or metastasis occurred in eight cases (three in the laparoscopic group and five in the open group). No significant difference in long-term disease-free survival was found between the two groups (P > 0.05).

Conclusion

When performed by experienced surgeons, laparoscopic resection for gastric GISTs larger than 5 cm is a safe and effective minimally invasive surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

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

    Article  CAS  PubMed  Google Scholar 

  2. Corless CL, Fletcher JA, Heinrich MC (2004) Biology of gastrointestinal stromal tumors. J Clin Oncol 22(18):3813–3825

    Article  CAS  PubMed  Google Scholar 

  3. DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF (2000) Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 231(1):51–58

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Woodall CE, Brock GN, Fan J, Byam JA, Scoggins CR, McMasters KM, Martin RC (2009) An evaluation of 2537 gastrointestinal stromal tumors for a proposed clinical staging system. Arch Surg 144(7):670–678

    Article  PubMed  Google Scholar 

  5. Kong SH, Yang HK (2013) Surgical treatment of gastric gastrointestinal stromal tumor. J Gastric Cancer 13(1):3–18

    Article  PubMed Central  PubMed  Google Scholar 

  6. Blay JY, Bonvalot S, Casali P, Choi H, Debiec-Richter M, Dei Tos AP, Emile JF, Gronchi A, Hogendoorn PC, Joensuu H, Le Cesne A, McClure J, Maurel J, Nupponen N, Ray-Coquard I, Reichardt P, Sciot R, Stroobants S, van Glabbeke M, van Oosterom A, Demetri GD (2005) Consensus meeting for the management of gastrointestinal stromal tumors. Report of the GIST Consensus Conference of 20–21 March 2004, under the auspices of ESMO. Ann Oncol 16(4):566–578

    Article  PubMed  Google Scholar 

  7. Joensuu H (2008) Risk stratification of patients diagnosed with gastrointestinal stromal tumor. Hum Pathol 39(10):1411–1419

    Article  PubMed  Google Scholar 

  8. Basu S, Balaji S, Bennett DH, Davies N (2007) Gastrointestinal stromal tumors (GIST) and laparoscopic resection. Surg Endosc 21(10):1685–1689

    Article  PubMed  Google Scholar 

  9. Lee JS, Kim JJ, Park SM (2011) Totally laparoscopic resection for a large gastrointestinal stromal tumor of stomach. J Gastric Cancer 11(4):239–242

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Demetri GD, Benjamin RS, Blanke CD, Blay JY, Casali P, Choi H, Corless CL, Debiec-Rychter M, DeMatteo RP, Ettinger DS, Fisher GA, Fletcher CD, Gronchi A, Hohenberger P, Hughes M, Joensuu H, Judson I, Le Cesne A, Maki RG, Morse M, Pappo AS, Pisters PW, Raut CP, Reichardt P, Tyler DS, Van den Abbeele AD, von Mehren M, Wayne JD, Zalcberg J (2007) NCCN task force report: management of patients with gastrointestinal stromal tumor (GIST)-update of the NCCN clinical practice guidelines. J Natl Compr Canc Netw 5(2):1–29

    Google Scholar 

  11. Casali PG, Jost L, Reichardt P, Schlemmer M, Blay JY (2009) ESMO Guidelines Working Group. Gastrointestinal stromal tumours: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 4:64–67

    Google Scholar 

  12. Joensuu H (2008) Risk stratification of patients diagnosed with gastrointestinal stromal tumor. Hum Pathol 39(10):1411–1419

    Article  PubMed  Google Scholar 

  13. Matthews BD, Joels CS, Kercher KW, Heniford BT (2004) Gastrointestinal stromal tumors of the stomach. Minerva Chir 59(3):219–231

    CAS  PubMed  Google Scholar 

  14. Selcukbiricik F, Yalçın S, Tural D, Erdamar S, Demir G, Doğusoy G, Mandel NM (2013) Gastrointestinal stromal tumors in Turkey: experiences from three centers. Onkologie 36(1–2):18–24

    Article  PubMed  Google Scholar 

  15. Blanke CD, Corless CL (2005) State-of-the art therapy for gastrointestinal stromal tumors. Cancer Invest 23(3):274–280

    Article  PubMed  Google Scholar 

  16. Mochizuki Y, Kodera Y, Fujiwara M, Ito S, Yamamura Y, Sawaki A, Yamao K, Kato T (2006) Laparoscopic wedge resection for gastrointestinal stromal tumors of the stomach: initial experience. Surg Today 36(4):341–347

    Article  PubMed  Google Scholar 

  17. Daigle C, Meneghetti AT, Lam J, Panton ON (2012) Laparoscopic management of gastrointestinal stromal tumours: review at a Canadian centre. Can J Surg 55(2):105–109

    Article  PubMed Central  PubMed  Google Scholar 

  18. Ma JJ, Hu WG, Zang L, Yan XW, Lu AG, Wang ML, Li JW, Feng B, Zhong J, Zheng MH (2011) Laparoscopic gastric resection approaches for gastrointestinal stromal tumors of stomach. Surg Laparosc Endosc Percutan Tech 21(2):101–105

    Article  PubMed  Google Scholar 

  19. Pitsinis V, Khan AZ, Cranshaw I, Allum WH (2007) Singlecenter experience of laparoscopic versus open resection for gastrointestinal stromal tumors of the stomach. Hepatogastroenterology 54(74):606–608

    CAS  PubMed  Google Scholar 

  20. Chen YH, Liu KH, Yeh CN, Hsu JT, Liu YY, Tsai CY, Chiu CT, Jan YY, Yeh TS (2012) Laparoscopic resection of gastrointestinal stromal tumors: safe, efficient, and comparable oncologic outcomes. J Laparoendosc Adv Surg Tech A 22(8):758–763

    Article  PubMed  Google Scholar 

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

    Article  PubMed Central  PubMed  Google Scholar 

  22. Karakousis GC, Singer S, Zheng J, Gonen M, Coit D, De-Matteo RP, Strong VE (2011) Laparoscopic versus open gastric resections for primary gastrointestinal stromal tumors (GISTs): a size-matched comparison. Ann Surg Oncol 18(6):1599–1605

    Article  PubMed  Google Scholar 

  23. Joensuu H, Vehtari A, Riihimäki J, Nishida T, Steigen SE, Brabec P, Plank L, Nilsson B, Cirilli C, Braconi C, Bordoni A, Magnusson MK, Linke Z, Sufliarsky J, Federico M, Jonasson JG, Dei Tos AP, Rutkowski P (2012) Risk of recurrence of gastrointestinal stromal tumour after surgery: an analysis of pooled population-based cohorts. Lancet Oncol 13(3):265–274

    Article  PubMed  Google Scholar 

  24. Nowain A, Bhakta H, Pais S, Kanel G, Verma S (2005) Gastrointestinal stromal tumors: clinical profile, pathogenesis, treatment strategies and prognosis. J Gastroenterol Hepatol 20(6):818–824

    Article  PubMed  Google Scholar 

  25. Fujimoto Y, Nakanishi Y, Yoshimura K, Shimoda T (2003) Clinicopathologic study of primary malignant gastrointestinal stromal tumor of the stomach, with special reference to prognostic factors: analysis of results in 140 surgically resected patients. Gastric Cancer 6(1):39–48

    Article  PubMed  Google Scholar 

  26. Joensuu H, Fletcher C, Dimitrijevic S, Silberman S, Roberts P, Demetri G (2002) Management of malignant gastrointestinal stromal tumours. Lancet Oncol 3(11):655–664

    Article  CAS  PubMed  Google Scholar 

  27. Reece-Smith AM, MacGoey P, Shah MA, Leeder P, Andrew DR, McCulloch T, Parsons SL (2012) A multi-centre analysis of the impact of updated risk stratification on follow-up of gastric gastro-intestinal stromal tumours in the post-imatinib era. Eur J Surg Oncol 38(6):484–489

    Article  CAS  PubMed  Google Scholar 

  28. Eisenberg BL, Harris J, Blanke CD, Demetri GD, Heinrich MC, Watson JC, Hoffman JP, Okuno S, Kane JM, von Mehren M (2009) Phase II trial of neoadjuvant/ adjuvant imatinib mesylate (IM) for advanced primary and metastatic/ recurrent operable gastrointestinal stromal tumor (GIST): early results of RTOG 0132/ACRIN 6665. J Surg Oncol 99(1):42–47

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Blesius A, Cassier PA, Bertucci F, Fayette J, Ray-Coquard I, Bui B, Adenis A, Rios M, Cupissol D, Perol D, Blay JY, Le Cesne A (2011) Neoadjuvant imatinib in patients with locally advanced non metastatic GIST in the prospective BFR14 trial. BMC Cancer 11:72

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Kodera Y, Fujiwara M, Ohashi N, Nakayama G, Koike M, Morita S, Nakao A (2010) Laparoscopic surgery for gastric cancer: a collective review with meta-analysis of randomized trials. J Am Coll Surg 211(5):677–686

    Article  PubMed  Google Scholar 

  31. Feng B, Sun J, Ling TL, Lu AG, Wang ML, Chen XY, Ma JJ, Li JW, Zang L, Han DP, Zheng MH (2012) Laparoscopic complete mesocolic excision (CME) with medial access for right-hemi colon cancer: feasibility and technical strategies. Surg Endosc 26(12):3669–3675

    Article  PubMed  Google Scholar 

  32. Bagshaw PF, Allardyce RA, Frampton CM, Frizelle FA, Hewett PJ, McMurrick PJ, Rieger NA, Smith JS, Solomon MJ, Stevenson AR (2012) Long-term outcomes of the Australasian Randomized Clinical Trial comparing laparoscopic and conventional open surgical treatments for colon cancer: the Australasian Laparoscopic Colon Cancer Study Trial. Ann Surg 256(6):915–919

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank the follow-up office established by the Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China. Supported by National Key Clinical Specialty Discipline Construction Program of China (No. [2012] 649).

Disclosures

All authors read and approved the final manuscript.

Author information

Authors and Affiliations

  1. Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian, China

    Jianxian Lin, Changming Huang, Chaohui Zheng, Ping Li, Jianwei Xie, Jiabin Wang & Jun Lu

Authors
  1. Jianxian Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Changming Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chaohui Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ping Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jianwei Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jiabin Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jun Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Changming Huang.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lin, J., Huang, C., Zheng, C. et al. Laparoscopic versus open gastric resection for larger than 5 cm primary gastric gastrointestinal stromal tumors (GIST): a size-matched comparison. Surg Endosc 28, 2577–2583 (2014). https://doi.org/10.1007/s00464-014-3506-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3506-x

Keywords

Search

Navigation