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Laparoscopic versus open resection of gastrointestinal stromal tumors: survival outcomes from the NCDB

  • 2018 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Studies comparing laparoscopic versus open resection of gastrointestinal stromal tumors (GIST) typically involve small comparative groups and often do not control for tumor size or stage of disease. The objective of this study was to compare adjusted survival outcomes for laparoscopic versus open GIST.

Method

The National Cancer Database (NCDB) from 2010 to 2014 was evaluated for gastric and small intestinal GIST resections. After stratification by disease stage and adjustment for patient demographics, comorbidity score, tumor size, and tumor location, 90-day mortality rates were compared based on laparoscopic versus open resection. Kaplan–Meier estimates of long-term survival were also compared. A Cox proportional hazards model was used to determine hazard ratios (HR) for survival.

Results

There were 5096 cases analyzed, including 2910 (57%) stage I, 954 (19%) stage II, and 1232 (24%) stage III cases. The distribution of laparoscopic versus open cases was 1291 (44%) versus 1619 (56%) for stage I, 318 (33%) versus 636 (67%) for stage II, and 286 (23%) versus 946 (77%) for stage III. There was no significant difference in adjusted 90-day mortality between laparoscopic and open resection. Kaplan–Meier estimates of long-term survival demonstrated improved overall survival curves for laparoscopic resection for stage I and stage II disease, but no significant difference for stage III disease. Factors associated with statistically significant higher adjusted overall mortality included older age (HR 1.06; p < 0.001), black race (HR 1.33; p = 0.04), higher comorbidity score (HR 1.47; p < 0.001), and small intestinal versus gastric tumor location (HR 1.28; p = 0.03). The hazards model suggested improved overall survival for females (HR 0.59; p < 0.001) and laparoscopic approach (HR 0.80; p = 0.06).

Conclusion

Laparoscopic and open GIST resection have comparable 90-day mortality with possible improved long-term survival with laparoscopy for early-stage disease. These findings support the use of laparoscopy as a viable and potentially more effective approach to GIST resection.

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Acknowledgements

The National Cancer Data Base (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. The CoC’s NCDB and the hospitals participating in the CoC NCDB are the source of the de-identified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Authors and Affiliations

  1. Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA

    Colette S. Inaba, Austin Dosch, Christina Y. Koh, Sarath Sujatha-Bhaskar, Brian R. Smith & Ninh T. Nguyen

  2. Center for Statistical Consulting, University of California Irvine, Irvine, CA, USA

    Marija Pejcinovska

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  1. Colette S. Inaba
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  2. Austin Dosch
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  3. Christina Y. Koh
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  7. Ninh T. Nguyen
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Correspondence to Ninh T. Nguyen.

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Disclosures

Dr. Smith is an educational consultant for Stryker, not relevant to this work. Drs. Inaba, Dosch, Koh, Sujatha-Bhaskar, and Nguyen, and Ms. Pejcinovska have no conflicts of interest or financial ties to disclose.

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Inaba, C.S., Dosch, A., Koh, C.Y. et al. Laparoscopic versus open resection of gastrointestinal stromal tumors: survival outcomes from the NCDB. Surg Endosc 33, 923–932 (2019). https://doi.org/10.1007/s00464-018-6393-8

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  • DOI: https://doi.org/10.1007/s00464-018-6393-8

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