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Laparoscopic Versus Open Surgery for Gastric Gastrointestinal Stromal Tumors: a Propensity Score Matching Analysis

Journal of Gastrointestinal Surgery volume 24, pages 1785–1794 (2020)Cite this article

Abstract

Background

Surgery is the first choice for the treatment of gastric gastrointestinal stromal tumors (GISTs). With the development of new instruments and techniques, the popularity of laparoscopic resection of GISTs has increased rapidly. Previous studies on the advantages of laparoscopic resection over open surgery are generally limited by methodology or data capacity. This study evaluated the efficacy of laparoscopic resection and open surgery in gastric GISTs using the propensity score matching (PSM) method.

Methods

Between January 2005 and December 2017, 1027 patients were diagnosed with primary GIST at our institution. Among them, 548 patients were enrolled in this study. Standard demographic and clinicopathological data were collected from our database. Selection bias was eliminated using the PSM methods.

Results

After PSM, 256 cases involved in the comparison (128 laparoscopic (LAP) vs. 128 open surgery (OPEN)) were randomly matched (1:1) by age, sex, body mass index, hypertension, diabetes, heart disease, year of surgery, tumor location, tumor size, mitotic rate, and treatment with adjuvant tyrosine kinase inhibitors. The LAP group was superior to the OPEN group in blood loss (χ2 = 6.048, P = 0.049), time to first flatus (49.41 ± 7.56 vs. 71.31 ± 4.87 h, P < 0.001), and hospital stay (10.21 ± 6.05 vs. 12.56 ± 5.43 days, P = 0.001). No significant differences were seen in either the relapse-free survival or overall survival between the LAP and OPEN groups. In tumors located in favorable locations, the LAP group showed less blood loss (P = 0.008) and less multivisceral resection (17.8% vs. 5.5%, P = 0.02).

Conclusions

Laparoscopic resection for gastric GISTs is associated with improved surgical outcomes and postoperative courses and comparable oncological outcomes, regardless of favorable or unfavorable tumor location.

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References

  1. Miettinen M, Lasota J. Histopathology of gastrointestinal stromal tumor.[J]. Journal of Surgical Oncology, 2011, 104(8):865-873.

    CAS  Article  Google Scholar 

  2. Joensuu H, Vehtari A, Riihimäki J, et al. Risk of recurrence of gastrointestinal stromal tumour after surgery: an analysis of pooled population-based cohorts.[J]. Lancet Oncology, 2012, 13(3):265-274.

    Article  Google Scholar 

  3. Hirota S , Isozaki K , Moriyama Y , et al. Gain-of-Function Mutations of c-kit in Human Gastrointestinal Stromal Tumors[J]. Science, 1998, 279(5350):577.

    CAS  Article  Google Scholar 

  4. Joensuu H , Dimitrijevic S . Tyrosine kinase inhibitor imatinib (STIS71) as an anticancer agent for solid tumours[J]. Annals of Medicine, 2001, 33(7):5.

    Article  Google Scholar 

  5. Dematteo R P, Ballman K V, Antonescu C R, et al. Adjuvant imatinib mesylate after resection of localised, primary gastrointestinal stromal tumour: a randomised, double-blind, placebo-controlled trial[J]. Lancet, 2009, 373(9669):1097-1104.

    CAS  Article  Google Scholar 

  6. Joensuu H, Eriksson M , Sundby H K , et al. One vs three years of adjuvant imatinib for operable gastrointestinal stromal tumor: A randomized trial[J]. Jama, 2012, 307(12):1265-72.

    CAS  Article  Google Scholar 

  7. Kimata M, Kubota T, Otani Y, et al. Gastrointestinal stromal tumors treated by laparoscopic surgery: report of three cases.[J]. Surgery Today, 2000, 30(2):177-180.

    CAS  Article  Google Scholar 

  8. Demetri G D , Mehren M V , Antonescu C R , et al. NCCN Task Force Report: Update on the Management of Patients with Gastrointestinal Stromal Tumors[J]. Journal of the National Comprehensive Cancer Network Jnccn, 2010, 8 Suppl 2(4):S1.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Demetri G D, Benjamin R S, Blanke C D, et al. NCCN Task Force report: management of patients with gastrointestinal stromal tumor (GIST)–update of the NCCN clinical practice guidelines[J]. J Natl Compr Canc Netw, 2007, 2(2 Suppl 1):S1.

    Article  Google Scholar 

  10. Goh B K P , Chow P K H , Chok A Y , et al. 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.[J]. World Journal of Surgery, 2010, 34(8):1847.

    Article  Google Scholar 

  11. Karakousis G C, Singer S , Zheng J , et al. Laparoscopic Versus Open Gastric Resections for Primary Gastrointestinal Stromal Tumors (GISTs): A Size-Matched Comparison [J]. Annals of Surgical Oncology, 2011, 18(6):1599-1605.

    Article  Google Scholar 

  12. De V K , Hoorens A , Haentjens P , et al. Laparoscopic versus open resection of gastrointestinal stromal tumors of the stomach.[J]. Surgical Endoscopy, 2013, 27(5):1546-1554.

    Article  Google Scholar 

  13. Bischof D A, Kim Y, Dodson R, et al. Open versus minimally invasive resection of gastric GIST: a multi-institutional analysis of short- and long-term outcomes.[J]. Annals of Surgical Oncology, 2014, 21(9):2941–2948.

    Article  Google Scholar 

  14. Hsiao C Y , Yang C Y , Lai I R , et al. Laparoscopic resection for large gastric gastrointestinal stromal tumor (GIST): intermediate follow-up results [J]. Surgical Endoscopy, 2015, 29(4):868-873.

    Article  Google Scholar 

  15. Paul R. Rosenbaum, Donald B. Rubin. The central role of the propensity score in observational studies for causal effects [J]. Biometrika, 1983, 70(1):41-55.

    Article  Google Scholar 

  16. 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 [J]. Surgical Endoscopy, 2017, 31(1):1-8.

    Article  Google Scholar 

  17. Joensuu H. Risk stratification of patients diagnosed with gastrointestinal stromal tumor [J]. Human Pathology, 2008, 39(10):1411-1419.

    Article  Google Scholar 

  18. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.[J]. Annals of Surgery, 2004, 240(2):205-213.

    Article  Google Scholar 

  19. Miettinen M, Lasota J. Gastrointestinal stromal tumors, version 2.2014[J]. Journal of the National Comprehensive Cancer Network Jnccn, 2014, 12(6):853-62.

    Article  Google Scholar 

  20. Austin P C. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples.[J]. Statistics in Medicine, 2009, 28(25):3083-3107.

    Article  Google Scholar 

  21. Piso P, Schlitt H J, Klempnauer J. Stromal sarcoma of the stomach: therapeutic considerations.[J]. European Journal of Surgery, 2010, 166(12):954-958.

    Google Scholar 

  22. Panagiotakis G, Spiridakis K, Chatziioannou M, et al. Surgical treatment of gastrointestinal stromal tumour of jejunum [J]. Hippokratia, 2011, 15(3):282-3.

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Goh B K, Chow P K, Kesavan S M, et al. Outcome after curative resection of large (>or=10 cm) gastric gastrointestinal stromal tumors: how frequent is adjacent organ involvement and is concomitant distal pancreatectomy necessary?[J]. Journal of Gastrointestinal Surgery, 2010, 14(4):607-613.

    Article  Google Scholar 

  24. Von M M, Randall R L, Benjamin R S, et al. Soft Tissue Sarcoma, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology.[J]. Journal of the National Comprehensive Cancer Network Jnccn, 2018, 16(5):536.

    Article  Google Scholar 

  25. von Mehren M, Joensuu H. Gastrointestinal Stromal Tumors[J]. J Clin Oncol, 2018,36(2):136-143. https://doi.org/10.1200/JCO.2017.74.9705.

    Article  Google Scholar 

  26. Bischof D A, Kim Y, Dodson R, et al. Open versus minimally invasive resection of gastric GIST: a multi-institutional analysis of short- and long-term outcomes.[J]. Annals of Surgical Oncology, 2014, 21(9):2941-2948.

    Article  Google Scholar 

  27. Zheng L, Ding W, Zhou D, et al. Laparoscopic versus open resection for gastric gastrointestinal stromal tumors: a meta-analysis. Am Surg. 2014;80:48–56.

    PubMed  Google Scholar 

  28. Chen K, Zhou YC, Mou YP, et al. Systematic review and meta-analysis of safety and efficacy of laparoscopic resection for gastrointestinal stromal tumors of the stomach. Surg Endosc. 2015;29:355–367.

    Article  Google Scholar 

  29. Koh YX, Chok AY, Zheng HL, et al. A Systematic Review and Meta-Analysis Comparing Laparoscopic Versus Open Gastric Resections for Gastrointestinal Stromal Tumors of the Stomach[J]. Ann Surg Oncol 2013;20(11):3549–60.

  30. Bischof D A, Kim Y, Dodson R, et al. Open versus minimally invasive resection of gastric GIST: a multi-institutional analysis of short- and long-term outcomes.[J]. Annals of Surgical Oncology, 2014, 21(9):2941-2948.

    Article  Google Scholar 

  31. Piessen G, Lefèvre J H, Cabau M, et al. Laparoscopic Versus Open Surgery for Gastric Gastrointestinal Stromal Tumors: What Is the Impact on Postoperative Outcome and Oncologic Results?[J]. Annals of Surgery, 2015, 262(5):831.

    Article  Google Scholar 

  32. Bot J, Piessen G, Robb W B, et al. Advanced tumor stage is an independent risk factor of postoperative infectious complications after colorectal surgery: arguments from a case-matched series [J]. Diseases of the Colon & Rectum, 2013, 56(5):568-576.

    Article  Google Scholar 

  33. Kim W, Kim HH, Han SU, et al. Decreased Morbidity of Laparoscopic Distal Gastrectomy Compared With Open Distal Gastrectomy for Stage I Gastric Cancer: Short-term Outcomes From a Multicenter Randomized Controlled Trial (KLASS-01)[J]. Annals of Surgery, 2016, 263(1):28.

    Article  Google Scholar 

  34. B. Goh, Y.C. Goh, A.K. Eng, et al. 126. Outcomes after laparoscopic versus open wedge resection for suspected gastric gastrointestinal stromal tumours: A matched-pair case-control study [J]. European Journal of Surgical Oncology, 2015, 41(7):905-910.

    CAS  Article  Google Scholar 

  35. Lee H H, Hur H, Jung H, et al. Laparoscopic wedge resection for gastric submucosal tumors: a size-location matched case-control study.[J]. Journal of the American College of Surgeons, 2011, 212(2):195–199.

    Article  Google Scholar 

  36. Lin J, Huang C, Zheng C, et al. Laparoscopic versus open gastric resection for larger than 5cm primary gastric gastrointestinal stromal tumors (GIST): a size-matched comparison [J]. Surgical Endoscopy, 2014, 28(9):2577.

    Article  Google Scholar 

  37. Hsiao CY, Yang CY, Lai IR, et al. Laparoscopic resection for large gastric gastrointestinal stromal tumor (GIST): intermediate follow-up results.[J]. Surgical Endoscopy, 2015, 29(4):868-873.

    Article  Google Scholar 

  38. Huang CM, Chen QF, Lin JX, et al. Can laparoscopic surgery be applied in gastric gastrointestinal stromal tumors located in unfavorable sites?: A study based on the NCCN guidelines[J]. Medicine, 2017, 96(14):e6535.

    Article  Google Scholar 

  39. Brar S S, Seevaratnam R, Cardoso R, et al. Multivisceral resection for gastric cancer: A systematic review [J]. Gastric Cancer, 2012, 15(1):100-107.

    Article  Google Scholar 

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Acknowledgments

This study was supported by the National Key Basic Research Program of China (2015CB5540007), the National Science and Technology Major Project (2017YFC0113503), the National Natural Science Foundation of China (No.81572413, 81702386 and 81874184), the Foundation of Independent Innovation Fund of Huazhong University of Science and Technology (2017KFYXJJ230 and 2017KFYXJJ256), and the Natural Science Foundation of Hubei Province (2016CFA100).

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Author notes

  1. Zhen Xiong and Wenze Wan contributed equally to this work.

Affiliations

  1. Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, Hubei Province, China

    Zhen Xiong, Wenze Wan, Xiangyu Zeng, Weizhen Liu, Tao Wang, Ruizhi Zhang, Chengguo Li, Wenchang Yang, Peng Zhang & Kaixiong Tao

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  1. Zhen Xiong
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Correspondence to Peng Zhang or Kaixiong Tao.

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Xiong, Z., Wan, W., Zeng, X. et al. Laparoscopic Versus Open Surgery for Gastric Gastrointestinal Stromal Tumors: a Propensity Score Matching Analysis. J Gastrointest Surg 24, 1785–1794 (2020). https://doi.org/10.1007/s11605-019-04318-6

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Keywords

  • GISTs
  • Laparoscopic surgery
  • Open surgery
  • Propensity score matching