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Open Versus Minimally Invasive Resection of Gastric GIST: A Multi-Institutional Analysis of Short- and Long-Term Outcomes

  • Bone and Soft Tissue Sarcomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. Overall surgical experience with minimally invasive surgery (MIS) has increased; however, published reports on MIS resection of GIST are limited to small, single-institution experiences.

Methods

A total of 397 patients who underwent open surgery (n = 230) or MIS (n = 167) for a gastric GIST between 1998 and 2012 were identified from a multicenter database. The impact of MIS approach on recurrence and survival was analyzed using propensity-score matching by comparing clinicopathologic factors between patients who underwent MIS versus open resection.

Results

There were 19 conversions (10 %) to open; the most common reasons for conversion were tumor more extensive than anticipated (26 %) and unclear anatomy (21 %). On multivariate analysis, smaller tumor size and higher body mass index (BMI) were associated with receipt of MIS. In the propensity-matched cohort (n = 248), MIS resection was associated with decreased length of stay (MIS, 3 days vs open, 8 days) and fewer ≥ grade 3 complications (MIS, 3 % vs open, 14 %) compared with open surgery. High rates of R0 resection and low rates of tumor rupture were seen in both groups. After propensity-score matching, there was no difference in recurrence-free or overall survival comparing the MIS and the open group (both p > 0.05).

Conclusions

An MIS approach for gastric GIST was associated with low morbidity and a high rate of R0 resection. The long-term oncological outcome following MIS was excellent, and therefore the MIS approach should be considered the preferred approach for gastric GIST in well-selected patients.

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Disclosures

Dr. Danielle A. Bischof completed this work while supported by the Detweiler Travelling Fellowship from the Royal College of Physicians and Surgeons of Canada.

Author information

Authors and Affiliations

  1. Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA

    Danielle A. Bischof MD, Yuhree Kim MD, MPH, Rebecca Dodson MD & Timothy M. Pawlik MD, MPH, PhD, FACS

  2. University Health Network, Toronto, ON, Canada

    M. Carolina Jimenez & Fayez A. Quereshy MD, MBA

  3. Department of Surgery, University of Toronto, Toronto, ON, Canada

    M. Carolina Jimenez, Ramy Behman MD, Paul J. Karanicolas MD, PhD, Calvin Law MD, MPH & Fayez A. Quereshy MD, MBA

  4. Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Ramy Behman MD, Paul J. Karanicolas MD, PhD & Calvin Law MD, MPH

  5. Department of Surgery, Duke University, Durham, NC, USA

    Andrei Cocieru MD & Dan G. Blazer III FACS, MD

  6. Department of Surgery, Emory University, Atlanta, GA, USA

    Sarah B. Fisher MD, Malcolm H. Squires III MD, MS, David A. Kooby MD & Shishir K. Maithel MD, FACS

  7. Medical College of Wisconsin, Milwaukee, WI, USA

    Ryan T. Groeschl MD & T. Clark Gamblin MD, FACS

  8. Department of Surgery, University of Virginia, Charlottesville, VA, USA

    Todd W. Bauer MD, FACS

Authors
  1. Danielle A. Bischof MD
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  2. Yuhree Kim MD, MPH
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  3. Rebecca Dodson MD
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  4. M. Carolina Jimenez
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  5. Ramy Behman MD
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  6. Andrei Cocieru MD
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  7. Dan G. Blazer III FACS, MD
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  8. Sarah B. Fisher MD
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  9. Malcolm H. Squires III MD, MS
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  10. David A. Kooby MD
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  11. Shishir K. Maithel MD, FACS
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  12. Ryan T. Groeschl MD
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  13. T. Clark Gamblin MD, FACS
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  14. Todd W. Bauer MD, FACS
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  15. Paul J. Karanicolas MD, PhD
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  16. Calvin Law MD, MPH
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  17. Fayez A. Quereshy MD, MBA
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  18. Timothy M. Pawlik MD, MPH, PhD, FACS
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Corresponding author

Correspondence to Timothy M. Pawlik MD, MPH, PhD, FACS.

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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. Ann Surg Oncol 21, 2941–2948 (2014). https://doi.org/10.1245/s10434-014-3733-3

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  • DOI: https://doi.org/10.1245/s10434-014-3733-3

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