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Surgical Endoscopy

, Volume 29, Issue 2, pp 355–367 | Cite as

Systematic review and meta-analysis of safety and efficacy of laparoscopic resection for gastrointestinal stromal tumors of the stomach

  • Ke Chen
  • Yu-Cheng Zhou
  • Yi-Ping Mou
  • Xiao-Wu Xu
  • Wei-Wei Jin
  • Harsha Ajoodhea
Article

Abstract

Objective

To evaluate the safety and efficacy of laparoscopic resection for gastrointestinal stromal tumors (GISTs) of the stomach with systematic review and meta-analysis.

Methods

The literature database before March, 2014 was extensively searched to retrieve the comparative studies of laparoscopic (LAP) and open resection (OPEN) for GISTs with a relevance of study goal. The inclusion and exclusion criteria were formulated. After a quality evaluation, the data were extracted. The Cochrane collaboration RevMan5.1 version software was used for meta-analysis.

Results

There are nineteen studies meeting the inclusion criteria for meta-analysis. The total sample size of these studies was 1,060 cases. The operation time was similar between the two groups [weighted mean difference (WMD) −7.20 min, 95 % confidence interval (CI) −25.65 to 11.25, P = 0.44)]. Compared to OPEN, however, LAP experienced less blood loss (WMD −54.21 ml, 95 % CI −82.65 to −25.77, P < 0.01), earlier time to flatus (WMD −1.34 days, 95 % CI −1.62 to −1.06, P < 0.01) and oral diet (WMD −1.80 days, 95 % CI −2.18 to −1.42, P < 0.01), shorter hospital stay (WMD −3.68 days, 95 % CI −4.52 to −2.85, P < 0.01) and decrease in overall complications [relative risk (RR) 0.51, 95 % CI 0.32–0.80, P < 0.01)]. In addition, the long-term follow-up result shows that there is no significant difference in the two groups of patients.

Conclusion

Laparoscopic resection for gastric GISTs is a safe and feasible procedure with less blood loss, less overall complications and quicker recovery. The long-term survival situation of patients mainly depends on the tumor itself risk, and laparoscopic surgery will not increase the risks of tumor relapse and metastasis.

Keywords

Gastrointestinal stromal tumor Gastrectomy Laparoscopy Complications Meta-analysis 

Notes

Acknowledgments

This study was supported by Zhejiang Key Subject of Medical Science Foundation (grant No.11-CX-21).

Disclosures

Ke Chen, Yu-Cheng Zhou, Yi-Ping Mou, Xiao-Wu Xu, Wei-Wei Jin and Harsha Ajoodhea have no conflict of interest or financial ties to disclose.

References

  1. 1.
    Miettinen M, Majidi M, Lasota J (2002) Pathology and diagnostic criteria of gastrointestinal stromal tumors (GISTs): a review. Eur J Cancer (Oxford, England: 1990) 38(Suppl 5):S39–S51CrossRefGoogle Scholar
  2. 2.
    Demetri GD, von Mehren M, Antonescu CR, DeMatteo RP, Ganjoo KN, Maki RG, Pisters PW, Raut CP, Riedel RF, Schuetze S, Sundar HM, Trent JC, Wayne JD (2010) NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumors. J Natl Compreh Cancer Netw (JNCCN). 8 Suppl 2: S1–S41; quiz S42-44Google Scholar
  3. 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 231:51–58PubMedCentralCrossRefPubMedGoogle Scholar
  4. 4.
    Xu X, Chen K, Zhou W, Zhang R, Wang J, Wu D, Mou Y (2013) Laparoscopic transgastric resection of gastric submucosal tumors located near the esophagogastric junction. J Gastrointest Surg 17:1570–1575CrossRefPubMedGoogle Scholar
  5. 5.
    Kang WM, Yu JC, Ma ZQ, Zhao ZR, Meng QB, Ye X (2013) Laparoscopic-endoscopic cooperative surgery for gastric submucosal tumors. World J Gastroenterol WJG 19:5720–5726CrossRefGoogle Scholar
  6. 6.
    Valle M, Federici O, Carboni F, Carpano S, Benedetti M, Garofalo A (2014) Gastrointestinal stromal tumors of the stomach: the role of laparoscopic resection. Single-centre experience of 38 cases. Surg Endosc 28:1040–1047CrossRefPubMedGoogle Scholar
  7. 7.
    Lee CH, Hyun MH, Kwon YJ, Cho SI, Park SS (2012) Deciding laparoscopic approaches for wedge resection in gastric submucosal tumors: a suggestive flow chart using three major determinants. J Am Coll Surg 215:831–840CrossRefPubMedGoogle Scholar
  8. 8.
    Grobmyer SR, Pieracci FM, Allen PJ, Brennan MF, Jaques DP (2007) Defining morbidity after pancreaticoduodenectomy: use of a prospective complication grading system. J Am Coll Surg 204:356–364CrossRefPubMedGoogle Scholar
  9. 9.
    Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ (Clinical research ed) 327:557–560CrossRefGoogle Scholar
  11. 11.
    Basu S, Balaji S, Bennett DH, Davies N (2007) Gastrointestinal stromal tumors (GIST) and laparoscopic resection. Surg Endosc 21:1685–1689CrossRefPubMedGoogle Scholar
  12. 12.
    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 22:758–763CrossRefPubMedGoogle Scholar
  13. 13.
    Fisher SB, Kim SC, Kooby DA, Cardona K, Russell MC, Delman KA, Staley CA 3rd, Maithel SK (2013) Gastrointestinal stromal tumors: a single institution experience of 176 surgical patients. Am Surg 79:657–665PubMedGoogle Scholar
  14. 14.
    Otani Y, Furukawa T, Yoshida M, Saikawa Y, Wada N, Ueda M, Kubota T, Mukai M, Kameyama K, Sugino Y, Kumai K, Kitajima M (2006) Operative indications for relatively small (2–5 cm) gastrointestinal stromal tumor of the stomach based on analysis of 60 operated cases. Surgery 139:484–492CrossRefPubMedGoogle Scholar
  15. 15.
    Wu JM, Yang CY, Wang MY, Wu MH, Lin MT (2010) Gasless laparoscopy-assisted versus open resection for gastrointestinal stromal tumors of the upper stomach: preliminary results. J Laparoendosc Adv Surg Techn Part A 20:725–729CrossRefGoogle Scholar
  16. 16.
    Shimizu S, Noshiro H, Nagai E, Uchiyama A, Mizumoto K, Tanaka M (2002) Laparoscopic wedge resection of gastric submucosal tumors. Digest Surg 19:169–173CrossRefGoogle Scholar
  17. 17.
    Matthews BD, Walsh RM, Kercher KW, Sing RF, Pratt BL, Answini GA, Heniford BT (2002) Laparoscopic vs open resection of gastric stromal tumors. Surg Endosc 16:803–807CrossRefPubMedGoogle Scholar
  18. 18.
    Ishikawa K, Inomata M, Etoh T, Shiromizu A, Shiraishi N, Arita T, Kitano S (2006) Long-term outcome of laparoscopic wedge resection for gastric submucosal tumor compared with open wedge resection. Surg Laparosc Endosc percutan Tech 16:82–85CrossRefPubMedGoogle Scholar
  19. 19.
    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 36:341–347CrossRefPubMedGoogle Scholar
  20. 20.
    Nishimura J, Nakajima K, Omori T, Takahashi T, Nishitani A, Ito T, Nishida T (2007) Surgical strategy for gastric gastrointestinal stromal tumors: laparoscopic vs. open resection. Surg Endosc 21:875–878CrossRefPubMedGoogle Scholar
  21. 21.
    Pitsinis V, Khan AZ, Cranshaw I, Allum WH (2007) Single center experience of laparoscopic vs. open resection for gastrointestinal stromal tumors of the stomach. Hepatogastroenterology 54:606–608PubMedGoogle Scholar
  22. 22.
    Catena F, Di Battista M, Fusaroli P, Ansaloni L, Di Scioscio V, Santini D, Pantaleo M, Biasco G, Caletti G, Pinna A (2008) Laparoscopic treatment of gastric GIST: report of 21 cases and literature’s review. J Gastrointest Surg 12:561–568CrossRefPubMedGoogle Scholar
  23. 23.
    Silberhumer GR, Hufschmid M, Wrba F, Gyoeri G, Schoppmann S, Tribl B, Wenzl E, Prager G, Laengle F, Zacherl J (2009) Surgery for gastrointestinal stromal tumors of the stomach. J Gastrointest Surg 13:1213–1219CrossRefPubMedGoogle Scholar
  24. 24.
    Goh BK, Chow PK, Chok AY, Chan WH, Chung YF, Ong HS, Wong WK (2010) Impact of the introduction of laparoscopic wedge resection as a surgical option for suspected small/medium-sized gastrointestinal stromal tumors of the stomach on perioperative and oncologic outcomes. World J Surg 34:1847–1852CrossRefPubMedGoogle Scholar
  25. 25.
    Karakousis GC, Singer S, Zheng J, Gonen M, Coit D, DeMatteo RP, Strong VE (2011) Laparoscopic versus open gastric resections for primary gastrointestinal stromal tumors (GISTs): a size-matched comparison. Ann Surg Oncol 18:1599–1605CrossRefPubMedGoogle Scholar
  26. 26.
    Dai QQ, Ye ZY, Zhang W, Lv ZY, Shao QS, Sun YS, Tao HQ (2011) [Laparoscopic versus open wedge resection for gastrointestinal stromal tumors of the stomach: a clinical controlled study]. Zhonghua wei chang wai ke za zhi =. Chin J Gastrointest Surg 14:603–605Google Scholar
  27. 27.
    De Vogelaere K, Hoorens A, Haentjens P, Delvaux G (2013) Laparoscopic versus open resection of gastrointestinal stromal tumors of the stomach. Surg Endosc 27:1546–1554CrossRefPubMedGoogle Scholar
  28. 28.
    Melstrom LG, Phillips JD, Bentrem DJ, Wayne JD (2012) Laparoscopic versus open resection of gastric gastrointestinal stromal tumors. Am J Clin Oncol 35:451–454CrossRefPubMedGoogle Scholar
  29. 29.
    Lee HH, Hur H, Jung H, Park CH, Jeon HM, Song KY (2011) Laparoscopic wedge resection for gastric submucosal tumors: a size-location matched case-control study. J Am Coll Surg 212:195–199CrossRefPubMedGoogle Scholar
  30. 30.
    Wan P, Yan C, Li C, Yan M, Zhu ZG (2012) Choices of surgical approaches for gastrointestinal stromal tumors of the stomach: laparoscopic versus open resection. Digest Surg 29:243–250CrossRefGoogle Scholar
  31. 31.
    Pucci MJ, Berger AC, Lim PW, Chojnacki KA, Rosato EL, Palazzo F (2012) Laparoscopic approaches to gastric gastrointestinal stromal tumors: an institutional review of 57 cases. Surg Endosc 26:3509–3514CrossRefPubMedGoogle Scholar
  32. 32.
    Kim KH, Kim MC, Jung GJ, Kim SJ, Jang JS, Kwon HC (2012) Long term survival results for gastric GIST: is laparoscopic surgery for large gastric GIST feasible? World J Surg Oncol 10:230PubMedCentralCrossRefPubMedGoogle Scholar
  33. 33.
    Shu ZB, Sun LB, Li JP, Li YC, Ding DY (2013) Laparoscopic versus open resection of gastric gastrointestinal stromal tumors. Chin J Cancer Res Chung-kuo yen cheng yen chiu 25:175–182Google Scholar
  34. 34.
    Lee PC, Lai PS, Yang CY, Chen CN, Lai IR, Lin MT (2013) A gasless laparoscopic technique of wide excision for gastric gastrointestinal stromal tumor versus open method. World J Surg Oncol 11:44PubMedCentralCrossRefPubMedGoogle Scholar
  35. 35.
    Chen K, Xu XW, Zhang RC, Pan Y, Wu D, Mou YP (2013) Systematic review and meta-analysis of laparoscopy-assisted and open total gastrectomy for gastric cancer. World J Gastroenterol WJG 19:5365–5376CrossRefGoogle Scholar
  36. 36.
    Law WL, Lee YM, Choi HK, Seto CL, Ho JW (2007) Impact of laparoscopic resection for colorectal cancer on operative outcomes and survival. Ann Surg 245:1–7PubMedCentralCrossRefPubMedGoogle Scholar
  37. 37.
    Chen K, Mou YP, Xu XW, Cai JQ, Wu D, Pan Y, Zhang RC (2014) Short-term surgical and long-term survival outcomes after laparoscopic distal gastrectomy with D2 lymphadenectomy for gastric cancer. BMC Gastroenterol 14:41PubMedCentralCrossRefPubMedGoogle Scholar
  38. 38.
    Ephgrave KS, Kleiman-Wexler R, Pfaller M, Booth B, Werkmeister L, Young S (1993) Postoperative pneumonia: a prospective study of risk factors and morbidity. Surgery 114:815–819; discussion 819-821Google Scholar
  39. 39.
    Schulz KF, Chalmers I, Hayes RJ, Altman DG (1995) Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. J Am Med Assoc JAMA 273:408–412CrossRefGoogle Scholar
  40. 40.
    Walsh RM, Heniford BT (2001) Laparoendoscopic treatment of gastric stromal tumors. Semin Laparosc Surg 8:189–194CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Ke Chen
    • 1
  • Yu-Cheng Zhou
    • 1
  • Yi-Ping Mou
    • 1
  • Xiao-Wu Xu
    • 1
  • Wei-Wei Jin
    • 1
  • Harsha Ajoodhea
    • 1
  1. 1.Department of General Surgery, Institute of Micro-invasive Surgery, School of Medicine, Sir Run Run Shaw HospitalZhejiang UniversityHangzhouChina

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