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Laparoscopic Versus Open Resection for Gastrointestinal Stromal Tumors (GISTs)

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Abstract

Purpose

Primary gastrointestinal stromal tumors (GISTs) are typically treated with open resection. There is growing interest in laparoscopic GIST resection; however, data is limited. We report our experience with GIST resections using both open and laparoscopic techniques.

Materials and Methods

Twenty-nine GIST patients underwent definitive intent resection at the University of Missouri from 1990 to 2010. Patients who underwent laparoscopic resection (n = 7) were matched on the basis of tumor size, age, tumor location, and National Comprehensive Cancer Network (NCCN) risk stratification with seven patients who underwent open resection. The two groups were compared with respect to age, gender, BMI, tumor size, tumor site, mitotic rate, surgical margins, NCCN risk stratification, estimated blood loss, hospital stay, surgical complications, disease recurrence, and overall survival.

Results

The cohorts did not differ with respect to age, gender, BMI, tumor location, tumor size, or positive margins (p > 0.05). Patients who underwent open resection had more NCCN high-risk patients, but the difference was not statistically significant (p = 0.08). There was significantly less estimated blood loss (median 15 vs. 150 mL, p < 0.05) and significantly shorter hospital stay (median 4 vs. 7 days, p < 0.05) for the laparoscopy group. There were no recurrences in the laparoscopy group, but there was one in the open group with a median follow-up of 55 and 63 months, respectively (p > 0.05). Five-year disease-free survival was 100 % for the laparoscopic group and 83 % for the open resection group.

Conclusions

Laparoscopic resection for appropriately selected GISTs is feasible and associated with significantly less blood loss and shorter hospitalizations compared to open resection. Further studies are needed to better define its role for GIST.

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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: Int J Pathol. 2001;438(1):1–12.

    Article  CAS  Google Scholar 

  2. Miettinen M, Sarlomo-Rikala M, Lasota J. Gastrointestinal stromal tumors: recent advances in understanding of their biology. Hum Pathol. 1999;30(10):1213–20.

    Article  CAS  PubMed  Google Scholar 

  3. Karakousis GC, Singer S, Zheng J, Gonen M, Coit D, DeMatteo RP, et al. Laparoscopic versus open gastric resections for primary gastrointestinal stromal tumors (GISTs): a size-matched comparison. Ann Surg Oncol. 2011;18(6):1599–605. doi:10.1245/s10434-010-1517-y.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bischof DA, Kim Y, Dodson R, Carolina Jimenez M, Behman R, Cocieru A, et al. Open versus minimally invasive resection of gastric GIST: a multi-institutional analysis of short- and long-term outcomes. Ann Surg Oncol. 2014;21(9):2941–8. doi:10.1245/s10434-014-3733-3.

    Article  PubMed  Google Scholar 

  5. Melstrom LG, Phillips JD, Bentrem DJ, Wayne JD. Laparoscopic versus open resection of gastric gastrointestinal stromal tumors. Am J Clin Oncol. 2012;35(5):451–4. doi:10.1097/COC.0b013e31821954a7.

    Article  PubMed  Google Scholar 

  6. Nishimura J, Nakajima K, Omori T, Takahashi T, Nishitani A, Ito T, et al. Surgical strategy for gastric gastrointestinal stromal tumors: laparoscopic vs. open resection. Surg Endosc. 2007;21(6):875–8. doi:10.1007/s00464-006-9065-z.

    Article  PubMed  Google Scholar 

  7. Demetri GD, von Mehren M, Antonescu CR, DeMatteo RP, Ganjoo KN, Maki RG, et al. NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Cancer Netw: JNCCN. 2010;8(2):S1–41. quiz S42-44.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Corless CL, Heinrich MC. Molecular pathobiology of gastrointestinal stromal sarcomas. Annu Rev Pathol. 2008;3:557–86. doi:10.1146/annurev.pathmechdis.3.121806.151538.

    Article  CAS  PubMed  Google Scholar 

  9. Tran T, Davila JA, El-Serag HB. The epidemiology of malignant gastrointestinal stromal tumors: an analysis of 1,458 cases from 1992 to 2000. Am J Gastroenterol. 2005;100(1):162–8. doi:10.1111/j.1572-0241.2005.40709.x.

    Article  PubMed  Google Scholar 

  10. 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(1):51–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Emory TS, Sobin LH, Lukes L, Lee DH, O’Leary TJ. Prognosis of gastrointestinal smooth-muscle (stromal) tumors: dependence on anatomic site. Am J Surg Pathol. 1999;23(1):82–7.

    Article  CAS  PubMed  Google Scholar 

  12. Liegl B, Hornick JL, Lazar AJ. Contemporary pathology of gastrointestinal stromal tumors. Hematol Oncol Clin North Am. 2009;23(1):49–68. doi:10.1016/j.hoc.2008.12.002. vii-viii.

    Article  PubMed  Google Scholar 

  13. Reith JD, Goldblum JR, Lyles RH, Weiss SW. Extragastrointestinal (soft tissue) stromal tumors: an analysis of 48 cases with emphasis on histologic predictors of outcome. Modern Pathol: Off J U S Can Acad Pathol Inc. 2000;13(5):577–85. doi:10.1038/modpathol.3880099.

    Article  CAS  Google Scholar 

  14. Miettinen M, Monihan JM, Sarlomo-Rikala M, Kovatich AJ, Carr NJ, Emory TS, et al. Gastrointestinal stromal tumors/smooth muscle tumors (GISTs) primary in the omentum and mesentery: clinicopathologic and immunohistochemical study of 26 cases. Am J Surg Pathol. 1999;23(9):1109–18.

    Article  CAS  PubMed  Google Scholar 

  15. Aparicio T, Boige V, Sabourin JC, Crenn P, Ducreux M, Le Cesne A, et al. Prognostic factors after surgery of primary resectable gastrointestinal stromal tumours. Eur J Surg Oncol: J Eur Soc Surg Oncol Br Assoc Surg Oncol. 2004;30(10):1098–103. doi:10.1016/j.ejso.2004.06.016.

    Article  CAS  Google Scholar 

  16. 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 Cancer Netw: JNCCN. 2007;5(2):S1–29. quiz S30.

    PubMed  Google Scholar 

  17. Nguyen SQ, Divino CM, Wang JL, Dikman SH. Laparoscopic management of gastrointestinal stromal tumors. Surg Endosc. 2006;20(5):713–6. doi:10.1007/s00464-005-0435-8.

    Article  CAS  PubMed  Google Scholar 

  18. Wang W, Li Z, Tang J, Wang M, Wang B, Xu Z. Laparoscopic versus open total gastrectomy with D2 dissection for gastric cancer: a meta-analysis. J Cancer Res Clin Oncol. 2013;139(10):1721–34. doi:10.1007/s00432-013-1462-9.

    Article  PubMed  Google Scholar 

  19. 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(2):232–7.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ. Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg. 2010;97(11):1638–45. doi:10.1002/bjs.7160.

    Article  CAS  PubMed  Google Scholar 

  21. Jeong SY, Park JW, Nam BH, Kim S, Kang SB, Lim SB, et al. Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol. 2014;15(7):767–74. doi:10.1016/S1470-2045(14)70205-0.

    Article  PubMed  Google Scholar 

  22. Huguet KL, Rush Jr RM, Tessier DJ, Schlinkert RT, Hinder RA, Grinberg GG, et al. Laparoscopic gastric gastrointestinal stromal tumor resection: the Mayo Clinic experience. Arch Surg. 2008;143(6):587–90. doi:10.1001/archsurg.143.6.587. discussion 591.

    Article  PubMed  Google Scholar 

  23. Novitsky YW, Kercher KW, Sing RF, Heniford BT. Long-term outcomes of laparoscopic resection of gastric gastrointestinal stromal tumors. Ann Surg. 2006;243(6):738–45. doi:10.1097/01.sla.0000219739.11758.27. discussion 745-737.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Tabrizian P, Nguyen SQ, Divino CM. Laparoscopic management and longterm outcomes of gastrointestinal stromal tumors. J Am Coll Surg. 2009;208(1):80–6. doi:10.1016/j.jamcollsurg.2008.08.028.

    Article  PubMed  Google Scholar 

  25. Oida Y, Motojuku M, Morikawa G, Mukai M, Shimizu K, Imaizumi T, et al. Laparoscopic-assisted resection of gastrointestinal stromal tumor in small intestine. Hepato-Gastroenterology. 2008;55(81):146–9.

    PubMed  Google Scholar 

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Author notes

    Authors and Affiliations

    1. Department of Surgery, University of Missouri School of Medicine, Columbia, MO, 65212, USA

      Kelly M. MacArthur & Michael B. Nicholl

    2. Department of Dermatology, Johns Hopkins Hospital, Baltimore, MD, 21287, USA

      Kelly M. MacArthur

    3. Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA

      Brian C. Baumann

    4. South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA

      Michael B. Nicholl

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    1. Kelly M. MacArthur
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    2. Brian C. Baumann
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    Correspondence to Michael B. Nicholl.

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    Kelly M. MacArthur and Brian C. Baumann contributed equally to this work.

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    MacArthur, K.M., Baumann, B.C. & Nicholl, M.B. Laparoscopic Versus Open Resection for Gastrointestinal Stromal Tumors (GISTs). J Gastrointest Canc 48, 20–24 (2017). https://doi.org/10.1007/s12029-016-9861-1

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