Abstract
Background
Surgical resection with a free margin is considered the gold standard for the treatment of gastric gastrointestinal stromal tumors (GISTs). Previous studies about the advantages of laparoscopic resection versus open surgery have generally been non-randomized and retrospective and have some obvious shortcomings that could influence the veracity and reliability of the results. Therefore, the aim of this study was to evaluate the efficacy of laparoscopic resection in the treatment of gastric GISTs using the propensity score matching (PSM) method.
Methods
Between 2005 and 2014, 217 consecutive patients undergoing laparoscopic or open resection for gastric GISTs were enrolled in a retrospective, single-center study. Patient and tumor characteristics, intraoperative and postoperative characteristics, and oncologic outcomes were collected from a database. The efficacy of the laparoscopic approach was analyzed using the PSM method by comparing the clinical parameters of patients who underwent laparoscopic (LAP) and open resection (OPEN) procedures.
Results
After PSM, 88 patients involved in the analysis (44 LAP vs. 44 OPEN) were randomly matched (1:1) by tumor size, localization, disease course, body mass index, age, and gender. The LAP group was clearly superior to the open group in terms of intraoperative indicators and postoperative short-term efficacy. The incidence of postoperative complications in the LAP group was lower than in the OPEN group (4.5 vs. 18.2 %, P = 0.044). A survival analysis showed that there was no significant difference in the disease-free survival time between the two groups (χ 2 = 0.211, P = 0.646).
Conclusion
These data should be processed using the PSM method in a non-randomized controlled trial (non-RCT) study. It is safe and feasible for patients with gastric GISTs up to 5 cm in size or located in the gastroesophageal junction to be treated with laparoscopic surgery.
Similar content being viewed by others
References
Von Mehren M (2003) New therapeutic strategies for soft tissue sarcomas. Curr Treat Options Oncol 4:441–451. doi:10.1007/s11864-003-0045-4
Joensuu H, Fletcher C, Dimitrijevic S, Silberman S, Roberts P, Demetri G (2002) Management of malignant gastrointestinal stromal tumours. Lancet Oncol 3:655–664. doi:10.1016/S1470-2045(02)00899-9
Ducimetière F, Lurkin A, Ranchère-Vince D, Decouvelaere AV, Isaac S, Claret-Tournier C, Suignard Y, Salameire D, Cellier D, Alberti L, Bringuier PP, Blay JY, Ray-Coquard I (2010) Incidence rate, epidemiology of sarcoma and molecular biology. Preliminary results from EMS study in the Rhône-Alpes region. Bull Cancer 97:629–641. doi:10.1684/bdc.2010.1117
Lai IR, Lee WJ, Yu SC (2006) Minimally invasive surgery for gastric stromal cell tumors: intermediate follow-up results. J Gastrointest Surg 10:563–566. doi:10.1016/j.gassur.2005.08.028
Novitsky YW, Kercher KW, Sing RF, Heniford BT (2006) Long-term outcomes of laparoscopic resection of gastric gastrointestinal stromal tumors. Ann Surg 243:738–745; discussion 745. doi:10.1097/01.sla.0000219739.11758.27
Choi SM, Kim MC, Jung GJ, Kim HH, Kwon HC, Choi SR, Jang JS, Jeong JS (2007) Laparoscopic wedge resection for gastric GIST: long-term follow-up results. Eur J Surg Oncol 33:444–447. doi:10.1016/j.ejso.2006.11.003
De Vogelaere K, Hoorens A, Haentjens P, Delvaux G (2013) Laparoscopic versus open resection of gastrointestinal stromal tumors of the stomach. Surg Endosc 27:1546–1554. doi:10.1007/s00464-012-2622-8
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 10:230. doi:10.1186/1477-7819-10-230
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 212:195–199. doi:10.1016/j.jamcollsurg.2010.10.008
Shu ZB, Sun LB, Li JP, Li YC, Ding DY (2013) Laparoscopic versus open resection of gastric gastrointestinal stromal tumors. Chin J Cancer Res 25:175–182. doi:10.3978/j.issn.1000-9604.2013.02.03
Takahashi T, Nakajima K, Miyazaki Y, Miyazaki Y, Kurokawa Y, Yamasaki M, Miyata H, Takiguchi S, Nishida T, Mori M, Doki Y (2015) Surgical strategy for the gastric gastrointestinal stromal tumors (GISTs) larger than 5 cm: laparoscopic surgery is feasible, safe, and oncologically acceptable. Surg Laparosc Endosc Percutaneous Tech 25:114–118. doi:10.1097/SLE.0000000000000039
West SG, Cham H, Thoemmes F, Renneberg B, Schulze J, Weiler M (2014) Propensity scores as a basis for equating groups: basic principles and application in clinical treatment outcome research. J Consult Clin Psychol 82:906–919. doi:10.1037/a0036387
Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O’Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW (2002) Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol 33:459–465. doi:10.1053/hupa.2002.123545
Nilsson B, Bümming P, Meis-Kindblom JM, Odén A, Dortok A, Gustavsson B, Sablinska K, Kindblom LG (2005) Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era—a population-based study in western Sweden. Cancer 103:821–829. doi:10.1002/cncr.20862
Casali PG, Jost L, Reichardt P, Schlemmer M, Blay J-Y (2009) Gastrointestinal stromal tumours: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 20(Suppl. 4):iv64–iv67. doi:10.1093/annonc/mdp131
Reichardt P, Blay JY, Mehren MV (2010) Towards global consensus in the treatment of gastrointestinal stromal tumor. Expert Rev Anticancer Ther 10:221–232. doi:10.1586/era.09.171
Berney CR (2015) Laparoscopic resection of locally advanced gastrointestinal stromal tumour (GIST) of the stomach following neoadjuvant imatinib chemoreduction. Int J Surg Case Rep 8C:103–106. doi:10.1016/j.ijscr.2015.01.045
Berman J, O’Leary TJ (2001) Gastrointestinal stromal tumor workshop. Hum Pathol 32:578–582. doi:10.1053/hupa.2001.25484
Joensuu H (2002) Treatment of inoperable gastrointestinal stromal tumor (GIST) with imatinib (Glivec, Gleevec). Med Klin 97(Suppl. 1):28–30
Balachandran VP, DeMatteo RP (2014) Gastrointestinal stromal tumors: who should get imatinib and for how long? Adv Surg 48:165–183. doi:10.1016/j.yasu.2014.05.014
Blanke CD, Rankin C, Demetri GD, Ryan CW, von Mehren M, Benjamin RS, Raymond AK, Bramwell VH, Baker LH, Maki RG, Tanaka M, Hecht JR, Heinrich MC, Fletcher CD, Crowley JJ, Borden EC (2008) Phase III randomized, intergroup trial assessing imatinib mesylate at two dose levels in patients with unresectable or metastatic gastrointestinal stromal tumors expressing the kit receptor tyrosine kinase: S0033. J Clin Oncol 26:626–632. doi:10.1200/JCO.2007.13.4452
Ashraf M, Jha J, Choudhry A, Aggarwal B, Nayak S, Chakraborty J, Majumder S, Biswas J (2011) Neoadjuvant and adjuvant therapy with imatinib for locally advanced gastrointestinal stromal tumors in eastern Indian patients. Asian Pac J Cancer Prev 12:2059–2064
Blesius A, Cassier PA, Bertucci F, Fayette J, Ray-Coquard I, Bui B, Adenis A, Rios M, Cupissol D, Pérol 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. doi:10.1186/1471-2407-11-72
Fiore M, Palassini E, Fumagalli E, Pilotti S, Tamborini E, Stacchiotti S, Pennacchioli E, Casali PG, Gronchi A (2009) Preoperative imatinib mesylate for unresectable or locally advanced primary gastrointestinal stromal tumors (GIST). Eur J Surg Oncol 35:739–745. doi:10.1016/j.ejso.2008.11.005
Kimata M, Kubota T, Otani Y, Ohgami M, Ishikawa Y, Yokoyama T, Issiki S, Abe S, Egawa T, Tokuyama J, Wada N, Kumai K, Kitajima M, Mukai M (2000) Gastrointestinal stromal tumors treated by laparoscopic surgery: report of three cases. Surg Today 30:177–180. doi:10.1007/s005950050038
Lima M, Gargano T, Ruggeri G, Pession A, Mariotto A, Maffi M (2015) Laparoscopic resection of a rare gastrointestinal stromal tumor in children. Springerplus 4:73. doi:10.1186/s40064-015-0850-9
Rosenbaum PR, Rubin DB (1983) The central role of the propensity score in observational studies for causal effects. Biometrika 70:41–45. doi:10.1093/biomet/70.1.41
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 18:1599–1605. doi:10.1245/s10434-010-1517-y
Kasetsermwiriya W, Nagai E, Nakata K, Nagayoshi Y, Shimizu S, Tanaka M (2014) Laparoscopic surgery for gastric gastrointestinal stromal tumor is feasible irrespective of tumor size. J Laparoendosc Adv Surg Tech A 24:123–129. doi:10.1089/lap.2013.0433
Lin J, Huang C, Zheng C, Li P, Xie J, Wang J, Lu J (2014) 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. doi:10.1007/s00464-014-3506-x
NCCN (2015) NCCN clinical practice guidelines in oncology. Version 1 Fort Washington, Penn.: National Comprehensive Cancer Network, Inc. http://www.nccn.org
Nguyen SQ, Divino CM, Wang JL, Dikman SH (2006) Laparoscopic management of gastrointestinal stromal tumors. Surg Endosc 20:713–716. doi:10.1007/s00464-005-0435-8
Tagaya N, Mikami H, Kogure H, Kubota K, Hosoya Y, Nagai H (2002) Laparoscopic intragastric stapled resection of gastric submucosal tumors located near the esophagogastric junction. Surg Endosc 16:177–179. doi:10.1007/s004640080158
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 (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(Suppl. 2):S1–S29
Acknowledgments
This work was supported by the Major Program of Science and Technology Program of Guangzhou, No. 201300000087; the Research Fund of Public Welfare in Health Industry, Heath Ministry of China, No. 201402015; and the Key Clinical Specialty Discipline Construction Program.
Author information
Authors and Affiliations
Corresponding authors
Ethics declarations
Disclosures
Chao Xu, Tao Chen, Yanfeng Hu, A. I. Balde, Hao Liu, Jiang Yu, Zhen Li, and Guoxin Li have no conflicts of interest or financial ties to disclose.
Additional information
Chao Xu and Tao Chen have contributed equally to this work in the design of the study and preparation of the manuscript and should be considered co-first authors.
Rights and permissions
About this article
Cite this article
Xu, C., Chen, T., Hu, Y. et al. Retrospective study of laparoscopic versus open gastric resection for gastric gastrointestinal stromal tumors based on the propensity score matching method. Surg Endosc 31, 374–381 (2017). https://doi.org/10.1007/s00464-016-4983-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-016-4983-x