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Teng TZJ, Ishraq F, Chay AFT, Tay KV. Lap-Endo cooperative surgery (LECS) in gastric GIST: updates and future advances. Surg Endosc 2023; 37:1672-1682. [PMID: 36220988 DOI: 10.1007/s00464-022-09691-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 09/25/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND With advancements in the field of laparoscopic and endoscopic techniques leading to improved patient outcomes, open resection has become increasingly outdated for the treatment of gastric gastrointestinal stromal tumours (GIST). This is further superseded with the advent of laparoscopic and endoscopic cooperative surgery (LECS), an amalgamation of the two techniques to further improve results garnered while overcoming prior limitations each had individually. METHODS The electronic databases MEDLINE, Embase and PubMed were reviewed up to August 2021, using terms relating to LECS and gastric GIST. Relevant in-article references not returned in the searches were also considered. RESULTS Advancements in the field of laparoscopic and endoscopic techniques has led to improved patient outcomes, making open resection a thing of the past for gastric GIST. This has become even more apparent with the advent of LECS, coupling two cutting edge techniques to further improve results garnered while overcoming prior limitations each had individually. LECS has gained much favour by reducing surgical margins due to endoscopic visualisation without being limited to smaller tumours, allowing for better anatomical and functional preservation of prior anatomy. Furthermore, hybrid approaches have improved perioperative outcomes, with reduction in procedure time, post-procedure hospital stay and lesser complications. Additionally, subtypes of LECS such as inverted LECS, closed LECS, non-exposed endoscopic wall-inversion surgery (NEWS) and laparoscopy-assisted endoscopic full-thickness resection (LAEFR) have been developed that allows the abdominal cavity to not be exposed to tumour cells and gastric contents by extracting the lesion transorally. CONCLUSIONS LECS and its subtypes being a combination of two advanced techniques shows a synergistic effect that is promising. However, despite all these advantages of enhanced safety and certainty, there remains areas that require further improvement.
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Affiliation(s)
- Thomas Zheng Jie Teng
- General Surgery, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore.
- Undergraduate Medicine, Lee Kong Chian School of Medicine, Singapore, 308232, Singapore.
| | - Farhan Ishraq
- Undergraduate Medicine, Lee Kong Chian School of Medicine, Singapore, 308232, Singapore
| | - Amelia Fang Ting Chay
- Undergraduate Medicine, Lee Kong Chian School of Medicine, Singapore, 308232, Singapore
| | - Kon Voi Tay
- General Surgery, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore
- General Surgery, Woodlands Health Campus, 2 Yishun Central, Singapore, 768024, Singapore
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Winder A, Strauss DC, Jones RL, Benson C, Messiou C, Chaudry MA, Smith MJ. Robotic surgery for gastric gastrointestinal stromal tumors: A single center case series. J Surg Oncol 2020; 122:691-698. [PMID: 32488872 DOI: 10.1002/jso.26053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/06/2020] [Accepted: 05/21/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of surgical treatment of gastrointestinal stromal tumors (GIST) is a microscopically complete resection. Initial indications for laparoscopic surgery were limited to smaller tumors, in favorable locations. Over time, indications for minimal invasive surgery (MIS) have expanded, however concerns remain when considering resection of larger GISTs. Our aims were to assess the utility of robotic resection of gastric GISTs for challenging tumors. METHODS GIST resections, in this study were performed using the Intuitive Da Vinci Surgical Xi System. GIST's were considered challenging if tumor size was >50 mm at the time of surgery and/or the location of the tumor was type II, III, or IV using Privette/Al-Thanai classification. RESULTS Robotic resections were performed on 12 consecutive patients, 83% were considered challenging cases, 6 out of 12 for location and 5 out of 12 for size. Initial median tumor size on imaging was 53.7 mm, and post-imatinib was 45.8 mm. All tumors were removed with clear margins (R0) via wedge resections, with no complications. Median operative time was 192 minutes (95-250). Length of hospital stay was 2 days (2-6). CONCLUSIONS Robotic resection of gastric GIST's appears oncologically safe, and may expand the benefits of MIS to a greater cohort of complex cases.
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Affiliation(s)
- Alec Winder
- Department of Academic Surgery, Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden Hospital, London, UK
| | - Dirk C Strauss
- Department of Academic Surgery, Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden Hospital, London, UK
| | - Robin L Jones
- Department of Academic Surgery, Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden Hospital, London, UK
| | - Charlotte Benson
- Department of Academic Surgery, Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden Hospital, London, UK
| | | | - Mohammed Asif Chaudry
- Department of Oesophageal and Gastric Cancer Surgery, The Royal Marsden Hospital, London, UK
| | - Myles J Smith
- Department of Academic Surgery, Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden Hospital, London, UK
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Laparoscopic versus open wedge resection for gastrointestinal stromal tumors of the stomach: a meta-analysis. Wideochir Inne Tech Maloinwazyjne 2019; 14:149-159. [PMID: 31118977 PMCID: PMC6528119 DOI: 10.5114/wiitm.2018.79933] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/02/2018] [Indexed: 11/20/2022] Open
Abstract
Introduction With the rapid development of minimally invasive surgery, laparoscopic (LAP) wedge resection has become the first-choice treatment for primary gastrointestinal stromal tumors (GISTs) of the stomach. Aim To investigate the safety and feasibility of LAP wedge resection and the choice of surgical treatment for GISTs of the stomach through a meta-analysis and systematic review. Material and methods The literature was widely searched for comparative studies on open (OPEN) and LAP wedge resection for GISTs published before April 2017. The articles were selected after quality assessment. Results Ten reports met the inclusion criteria, with a total sample size of 485 cases. The operation time was similar between the 2 groups (weighted mean difference (WMD): 8.67 min, 95% confidence interval (CI): –8.60 to 25.94, p = 0.33). However, LAP resulted in less blood loss (WMD –32.20 ml, 95% CI: –56.15 to –8.26, p < 0.01), earlier time to flatus (WMD –1.48 days, 95% CI: –1.90 to –1.06, p < 0.01) and to an oral diet (WMD –1.50 days, 95% CI: –2.25 to –0.47, p < 0.01), shorter hospital stay (WMD –2.03 days, 95% CI: –2.68 to –1.38, p < 0.01), and a decreased overall complication rate (relative risk: 0.48, 95% CI: 0.25–0.89, p = 0.01) compared with OPEN. Moreover, long-term follow-up findings indicated no obvious difference between the 2 groups. Conclusions The use of LAP wedge resection for suitable cases is safe and feasible because it causes less blood loss and fewer overall complications and enables faster recovery.
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Robotic Gastrotomy With Intracorporeal Suture for Patients With Gastric Gastrointestinal Stromal Tumors Located at Cardia and Subcardiac Region. Surg Laparosc Endosc Percutan Tech 2018; 28:e1-e7. [PMID: 29215507 PMCID: PMC5802256 DOI: 10.1097/sle.0000000000000498] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Few studies of robotic gastric gastrointestinal stromal tumors (GISTs) resection have been conducted. This study was aimed to evaluate the robotic gastrotomy with intracorporeal suture for patients with GISTs located at cardia and subcardiac region. MATERIALS AND METHODS From January 2014 to August 2016, 11 patients with GISTs located at cardia and subcardiac region underwent robotic gastrotomy with intracorporeal suture. Data of these patients were collected. RESULTS The mean operative time was 82.7 minutes and the mean blood loss was 30.0 mL. No complication was reported. The postoperative length of stay was 3.3 days. On postoperative day 14, inflammation recovered to preoperative level. On postoperative month 6, the nutritional status was similar to that before the surgery. After 25.5 months follow-up, all patients survived with no recurrence or metastasis. CONCLUSIONS Robotic gastrotomy with intracorporeal suture for patients with GISTs located at cardia and subcardiac region is safe and feasible.
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Feasibility of Laparoscopic Resection of Gastrointestinal Stromal Tumor of the Stomach. J Laparoendosc Adv Surg Tech A 2018; 28:569-573. [DOI: 10.1089/lap.2017.0564] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Koh YX, Goh BKP. Minimally invasive surgery for gastric gastrointestinal stromal tumors. Transl Gastroenterol Hepatol 2017; 2:108. [PMID: 29354765 DOI: 10.21037/tgh.2017.11.20] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 11/27/2017] [Indexed: 12/19/2022] Open
Abstract
Minimally invasive surgery has been increasingly performed for gastric gastrointestinal stromal tumors (GIST). In this review we discuss and summarize the current evidence on minimally invasive surgery for gastric GISTs. Laparoscopic resection for gastric GIST has been consistently shown to be associated with superior perioperative outcomes with no compromise in oncological outcomes when compared to open resection in numerous retrospective case-control studies. It has also been shown to be safe and feasible for large tumors or tumors located in unfavorable sites. However, to date, there remains a lack of level 1 evidence from prospective randomized control trials in support of laparoscopic resection.
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Affiliation(s)
- Ye-Xin Koh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore.,Duke NUS Medical School, Singapore, Singapore
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Kim JJ, Lim JY, Nguyen SQ. Laparoscopic resection of gastrointestinal stromal tumors: Does laparoscopic surgery provide an adequate oncologic resection? World J Gastrointest Endosc 2017; 9:448-455. [PMID: 28979709 PMCID: PMC5605344 DOI: 10.4253/wjge.v9.i9.448] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 06/30/2017] [Accepted: 07/24/2017] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are rare tumors of the GI tract. Surgical resection remains the mainstay of non-metastatic disease. However, the ability to provide an adequate oncologic resection using laparoscopic surgery is still an area of debate. This is a thorough review of the current literature, looking particularly at the use of laparoscopic surgery for larger GISTs and the long-term oncologic outcomes compared to the results of open surgery. Laparoscopic resections provide an adequate oncologic result for GISTs of all sizes, including those greater than 5 cm in size.
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Affiliation(s)
- Joseph J Kim
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - James Y Lim
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Scott Q Nguyen
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
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Ye L, Wu X, Wu T, Wu Q, Liu Z, Liu C, Li S, Chen T. Meta-analysis of laparoscopic vs. open resection of gastric gastrointestinal stromal tumors. PLoS One 2017; 12:e0177193. [PMID: 28486486 PMCID: PMC5423634 DOI: 10.1371/journal.pone.0177193] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 04/24/2017] [Indexed: 01/16/2023] Open
Abstract
Background This meta-analysis compared laparoscopic surgery (LAP) and open resection (OPEN) for the treatment of gastric gastrointestinal stromal tumors (GISTs) with regard to feasibility and safety. Methods We searched PubMed, Embase, and Web of Science for studies published before March 2016 comparing the LAP and OPEN procedures for GISTs. RevMan 5.1 software was used for the meta-analysis. Results In total, 28 studies met the inclusion criteria for the meta-analysis. The mean tumor sizes in the OPEN and LAP groups were 4.54 and 5.67 cm. Compared with the OPEN patients, the LAP patients experienced shorter surgical times (P = 0.05), less blood loss (P<0.01), earlier time to flatus (P<0.01) and an oral diet (P<0.01), and shorter hospital stays (P<0.01). The LAP patients also exhibited a decrease in overall complications (P<0.01). In addition, regarding the subgroup of larger GISTs (>5 cm), the present study did not report significant differences in operation time (P = 0.93), postoperative complications (P = 0.30), or recurrence rate (P = 0.61) between the two groups, though LAP was associated with favorable results regarding blood loss (P = 0.03) and hospital stay (P<0.01). Conclusions Compared with the OPEN procedure, the LAP procedure is associated with preferable short-term postoperative outcomes and does not compromise long-term oncological outcomes. For gastric GISTs >5 cm, no significant difference was detected between LAP and OPEN if patient selection and intraoperative decisions were carefully considered.
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Affiliation(s)
- Liangying Ye
- The First Clinical Medical College of southern medical university, Guangzhou, Guangdong Province, China
| | - Xiaojing Wu
- The First Clinical Medical College of southern medical university, Guangzhou, Guangdong Province, China
| | - Tongwei Wu
- The First Clinical Medical College of southern medical university, Guangzhou, Guangdong Province, China
| | - Qijing Wu
- The First Clinical Medical College of southern medical university, Guangzhou, Guangdong Province, China
| | - Zhao Liu
- The First Clinical Medical College of southern medical university, Guangzhou, Guangdong Province, China
| | - Chuan Liu
- The First Clinical Medical College of southern medical university, Guangzhou, Guangdong Province, China
| | - Sen Li
- Department of Spinal Surgery, Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
- * E-mail: (TC); (SL)
| | - Tao Chen
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
- * E-mail: (TC); (SL)
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Xiong H, Wang J, Jia Y, Ye C, Lu Y, Chen C, Shen J, Chen Y, Zhao W, Wang L, Zhou J. Laparoscopic surgery versus open resection in patients with gastrointestinal stromal tumors: An updated systematic review and meta-analysis. Am J Surg 2017; 214:538-546. [PMID: 28412996 DOI: 10.1016/j.amjsurg.2017.03.042] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 02/11/2017] [Accepted: 03/21/2017] [Indexed: 12/17/2022]
Abstract
PURPOSES The contemporary surgery has reported the safety of laparoscopic surgery (LAP) for patients with gastrointestinal stromal tumors (GISTs). However, its use is still debated due to suspicion of the oncologic equivalence to open surgery (OPEN). We conducted a systematic review and meta-analysis of updated original articles to investigate the short- and long-term clinical outcomes of LAP compared with OPEN for GISTs. METHODS A systematic search was performed in PubMed, Embase, Web of Science, Cochrane Library and CNKI. Comparative studies of laparoscopic and open surgery for GISTs were published before November 2016. The Newcastle-Ottawa scale was utilized to conduct quality assessment. The Review Manager (RevMan) software version 5.0 was used for meta-analysis. RESULTS Twenty-four studies involving 2140 patients were included for the meta-analysis. The meta-analysis results showed that, compared with OPEN, LAP indicated potentially favorable outcomes in terms of operative time (WMD, -30.71; 95% CI, -58.48 to -2.95; P = 0.03); intraoperative blood loss (WMD, -60.90; 95% CI, -91.53 to -30.28; P < 0.0001); time to flatus (WMD, -1.10; 95% CI, -1.41 to -0.79; P < 0.00001); time to oral intake (WMD, -1.25; 95% CI, -1.64 to -0.86; P < 0.00001); length of hospital stay (WMD, -3.42; 95% CI, -4.37 to -2.46; P < 0.00001); overall complications (OR, 0.38; 95% CI, 0.27 to 0.54; P < 0.00001); and recurrence (OR, 0.45; 95% CI, 0.30 to 0.66; P < 0.0001). CONCLUSIONS Laparoscopic surgery is safe and feasible for the treatment of GISTs including less operative time and intraoperative blood loss, earlier postoperative recovery, shorter hospital stay, and lower rate of overall complications and recurrence.
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Affiliation(s)
- Hanchu Xiong
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China; Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Ji Wang
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China; Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Yunlu Jia
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China; Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Chenyang Ye
- Cancer Institute (Key Laboratory of Cancer Prevention & Intervention, National Ministry of Education), Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yi Lu
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China; Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Cong Chen
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China; Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Jianguo Shen
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China; Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Yongxia Chen
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China; Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Wenhe Zhao
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China; Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Linbo Wang
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China; Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Hangzhou, Zhejiang, China.
| | - Jichun Zhou
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China; Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Hangzhou, Zhejiang, China.
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Chen QF, Huang CM, Lin M, Lin JX, Lu J, Zheng CH, Li P, Xie JW, Wang JB, Chen QY, Cao LL, Tu RH. Short- and Long-Term Outcomes of Laparoscopic Versus Open Resection for Gastric Gastrointestinal Stromal Tumors: A Propensity Score-Matching Analysis. Medicine (Baltimore) 2016; 95:e3135. [PMID: 27082552 PMCID: PMC4839796 DOI: 10.1097/md.0000000000003135] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Published reports on laparoscopic resection of gastric gastrointestinal stromal tumor (GIST) were limited to small experiences and selection bias. Two hundred fourteen patients who underwent primary gastric GIST resection at our institution (January 2006-December 2012) were identified from a prospectively collected database. Laparoscopic resections (LAP) were performed in 133 patients, and open resections (OPEN) were performed in 81 patients. The short- and long-term outcomes were analyzed using propensity-score matching (PSM) by comparing the clinicopathological factors between these groups. The tumor resection method and tumor size were significantly different between the LAP and OPEN groups. After PSM, there were no differences (P > 0.05) in these clinicopathological factors. The LAP group had less blood loss and shorter operation time, time to first flatus, time to first fluid diet, time to gastric tube removal, and postoperative stay before PSM. In addition, there were no differences regarding the time of drainage tube removal or hospitalization expense. Other than the time of gastric tube removal, which was similar in these 2 groups, the short-term outcomes were similar before and after PSM. The rates of postoperative complications in the LAP and OPEN groups were 6.8% and 22.8%, respectively, before PSM (P = 0.001) and 5.6% and 22.5%, respectively, after PSM (P = 0.004). The multivariate analyses for complications showed that tumors were located in the middle of the stomach, and the operation method and proximal gastrectomy were independent risk factors before and after PSM. The 5-year cumulative survival rates in the LAP and OPEN groups were 95.4% and 85.9%, respectively, (P = 0.07) before PSM and 93.1% and 91.9%, respectively, (P = 0.69) after PSM (not significantly different). Laparoscopic resection for gastric GISTs had better short-term outcomes and similar long-term outcomes compared with open surgery. Localized gastric GISTs can be treated with laparoscopic surgery.
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Affiliation(s)
- Qing-Feng Chen
- From the Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
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Laparoscopic resection of large gastric gastrointestinal stromal tumours. Wideochir Inne Tech Maloinwazyjne 2015; 11:31-37. [PMID: 28133498 PMCID: PMC4840182 DOI: 10.5114/wiitm.2015.56489] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 11/17/2015] [Indexed: 01/03/2023] Open
Abstract
Introduction Gastrointestinal stromal tumours (GISTs) are a rare class of neoplasms that are seen most commonly in the stomach. Due to their malignant potential, surgical resection is the recommended method for management of these tumours. Many reports have described the ability to excise small and medium sized GISTs laparoscopically, but laparoscopic resection of GISTs greater than 5 cm is still a matter of debate. Aim To investigate the feasibility and effectiveness of laparoscopic surgical techniques for management of large gastric GISTs greater than 4 cm and to detail characteristics of this type of tumour. Material and methods The study cohort consisted of 11 patients with suspected gastric GISTs who were treated from 2011 to April 2014 in a single institution. All patients underwent laparoscopic resection of a gastric GIST. Results Eleven patients underwent laparoscopic resection of a suspected gastric GIST between April 2011 and April 2014. The cohort consisted of 6 males and 5 females. Mean age was 67 years (range: 43–92 years). Sixty-four percent of these patients presented with symptomatic tumours. Four (36.4%) patients underwent laparoscopic transgastric resection (LTR), 3 (27.3%) laparoscopic sleeve gastrectomy (LSG), 3 (27.3%) laparoscopic wedge resection (LWR) and 1 (9%) laparoscopic distal gastrectomy (LDG). The mean operative time was 215 min. The mean tumour size was 6 cm (range: 4–9 cm). The mean tumour size for LTR was 5.5 cm (range: 4–6.3 cm), for LWR 5.3 cm (range: 4.5–7 cm), for LSG 6.5 cm (range: 4–9 cm) and for LDG 9 cm. We experienced only minor postoperative complications. Conclusions Laparoscopic procedures can be successfully performed during management of large gastric GISTs, bigger than 4 cm, and should be considered for all non-metastatic cases. The appropriate approach can be determined by assessing the anatomical location of each tumour.
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Cai JQ, Chen K, Mou YP, Pan Y, Xu XW, Zhou YC, Huang CJ. Laparoscopic versus open wedge resection for gastrointestinal stromal tumors of the stomach: a single-center 8-year retrospective cohort study of 156 patients with long-term follow-up. BMC Surg 2015; 15:58. [PMID: 25956520 PMCID: PMC4438531 DOI: 10.1186/s12893-015-0040-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 04/27/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The aim of this study was to compared laparoscopic (LWR) and open wedge resection (OWR) for the treatment of gastric gastrointestinal stromal tumors (GISTs). METHODS The data of 156 consecutive GISTs patients underwent LWR or OWR between January 2006 and December 2013 were collected retrospectively. The surgical outcomes and the long-term survival rates were compared. Besides, a rapid systematic review and meta-analysis were conducted. RESULTS Clinicopathological characteristics of the patients were similar between the two groups. The LWR group was associated with less intraoperative blood loss (67.3 vs. 142.7 ml, P < 0.001), earlier postoperative flatus (2.3 vs. 3.2 days, P < 0.001), earlier oral intake (3.2 vs. 4.1 days, P < 0.001) and shorter postoperative hospital stay (6.0 vs. 8.0 days, P = 0.001). The incidence of postoperative complications was lower in LWR group but did not reach statistical significance (4/90, 4.4% vs. 8/66, 12.1%, P = 0.12). No significant difference was observed in 3-year relapse-free survival rate between the two groups (98.6% vs. 96.4%, P > 0.05). The meta-analysis revealed similar results except less overall complications in the LWR group (RR = 0.49, 95% CI, 0.25 to 0.95, P = 0.04). And the recurrence risk was similar in two group (RR = 0.80, 95% CI, 0.28 to 2.27, P > 0.05). CONCLUSIONS LWR is a technically and oncologically safe and feasible approach for gastric GISTs compared with OWR. Moreover, LWR appears to be a preferable choice with mini-invasive benefits.
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Affiliation(s)
- Jia-Qin Cai
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China
| | - Ke Chen
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China
| | - Yi-Ping Mou
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China.
| | - Yu Pan
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China
| | - Xiao-Wu Xu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China
| | - Yu-Cheng Zhou
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China
| | - Chao-Jie Huang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China
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Outcome after laparoscopic versus open wedge resection for suspected gastric gastrointestinal stromal tumors: A matched-pair case-control study. Eur J Surg Oncol 2015; 41:905-10. [PMID: 25913060 DOI: 10.1016/j.ejso.2015.04.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 02/17/2015] [Accepted: 04/07/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Laparoscopic resection of gastric gastrointestinal stromal tumors (GISTs) has been shown by several retrospective studies to be technically feasible and associated with favorable outcomes when compared to the open approach. This study aims to mitigate potential selection bias by performing a case control study of laparoscopic (LWR) versus open wedge resection (OWR) matched by resection type, location and tumor size. METHODS We retrospectively identified 50 consecutive patients who underwent LWR for a suspected gastric GIST from a prospective database and matched this cohort with 50 patients who underwent OWR. RESULTS There was no statistical difference between the key baseline clinicopathological features of patients' who underwent LWR versus OWR. Patients who underwent LWR had longer operating times [150 (range, 65-270) minutes vs 92.5 (25-200) minutes, P < .001] but decreased median blood loss [0 (0-300) ml vs 0 (0-1200) ml, P = .015], decreased frequency of intraoperative or postoperative blood transfusion [1 (2%) vs 8 (16%), P = .031], decreased median time to liquid diet [2 (0-5) vs 3 (1-7) days, P < .001], decreased median time to solid diet [3 (1-6) vs 5 (2-11) days, P < .001] and decreased postoperative stay [4 (2-10) vs 4.5 (3-17), P < .001] compared to OWR. There was no difference in oncological outcomes such as frequency of close margins (≤ 1 mm) and recurrence-free survival. CONCLUSION This matched case-control study provides supporting evidence that LWR results in superior perioperative outcomes compared to OWR without compromising on oncological outcomes.
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Chen QL, Pan Y, Cai JQ, Wu D, Chen K, Mou YP. Laparoscopic versus open resection for gastric gastrointestinal stromal tumors: an updated systematic review and meta-analysis. World J Surg Oncol 2014; 12:206. [PMID: 25022283 PMCID: PMC4123825 DOI: 10.1186/1477-7819-12-206] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 07/04/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In past decades, laparoscopic surgery has been introduced for the treatment of gastrointestinal stromal tumors (GISTs). Recently, additional studies comparing laparoscopic versus open surgery for gastric GISTs have been published, and an updated meta-analysis of this subject is necessary. METHODS A systematic search was conducted in PubMed, Embase, Cochrane Library, and Web of Science. Comparative studies of laparoscopic and open surgery for gastric GISTs published before June 2014 were identified from databases. The Newcastle-Ottawa Quality Assessment Scale was used to perform quality assessment and original data were extracted. The statistical software STATA (version 12.0) was used for the meta-analysis. RESULTS Finally, 22 studies, including a total of 1,166 cases, meet the inclusion criteria for meta-analysis. The operation time was similar between laparoscopic and open surgery. Compared to open surgery, laparoscopic resection was associated withless blood loss (WMD = -58.91 ml; 95% CI, -84.60 to -33.22 ml; P <0.01); earlier time to flatus (WMD = -1.31 d; 95% CI, -1.56 to -1.06, P <0.01) and oral diet (WMD = -1.75 d; 95% CI, -2.12 to -1.39; P <0.01); shorter hospital stay (WMD = -3.68 d; 95% CI, -4.47 to -2.88; P <0.01); and decreased overall complications (relative risk = 0.57; 95% CI, 0.37 to 0.89; P = 0.01). For long-term outcomes, there were no significant differences between two surgical procedures on recurrence. CONCLUSION Laparoscopic surgery for gastric GISTs is acceptable for selective patients with better short-term outcomes compared with open surgery. The long-term survival situation of patients mainly depends on the nature of tumor itself, and laparoscopic surgery was not associated with worse oncological outcomes.
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Affiliation(s)
| | | | | | | | | | - Yi-Ping Mou
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, 310016 Hangzhou, Zhejiang province, China.
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Chen K, Zhou YC, Mou YP, Xu XW, Jin WW, Ajoodhea H. Systematic review and meta-analysis of safety and efficacy of laparoscopic resection for gastrointestinal stromal tumors of the stomach. Surg Endosc 2014; 29:355-67. [PMID: 25005014 DOI: 10.1007/s00464-014-3676-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 05/26/2014] [Indexed: 12/11/2022]
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.
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Affiliation(s)
- Ke Chen
- Department of General Surgery, Institute of Micro-invasive Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
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Zhang XM, Wang Z, Liang JW, Zhou ZX. Analysis of laparoscopy-assisted gastric cancer operations performed by inexperienced junior surgeons. Asian Pac J Cancer Prev 2014; 15:5077-81. [PMID: 24998589 DOI: 10.7314/apjcp.2014.15.12.5077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
To clarify whether gastric cancer patients can benefit from laparoscopy-assisted surgery completed by junior surgeons under supervision of expert surgeons, data of 232 patients with gastric cancer underwent operation performed by inexperienced junior surgeons were reviewed. Of the 232 patients, 137 underwent laparoscopy- assisted resection and in 118 cases this approach was successful. All of these 118 patients were assigned to laparoscopic group in this study, 19 patients who were switched to open resection were excluded. All laparoscopic operations were performed under the supervision of expert laparoscopic surgeons. Some 95 patients receiving open resection were assigned to the open group. All open operations were completed independently by the same surgeons. Short-term outcomes including oncologic outcomes, operative time intra-operative blood loss, time to first flatus, time to first defecation, postoperative hospital stay and perioperative complication were compared between the two groups. The numbers of lymph nodes harvested in the laparoscopic and open groups were21.1±9.6 and 18.2±9.7 (p=0.029). There was no significant difference in the length of margins. The mean operative time was 215.9±32.2 min in laparoscopic group and 220.1±34.6min in the open group (p=0.866), and the mean blood loss in laparoscopic group was obviously less than that in open group (200.9±197.0ml vs 291.1±191.4ml; p=0.001). Time to first flatus in laparoscopic and open groups was 4.0±1.0 days and 4.3±1.2days respectively and the difference was not significant (p=0.135). Similarly no statically significant difference was noted for time to first defecation (4.7±1.6 vs 4.8±1.6, p=0.586). Eleven patients in the laparoscopic group and 19 in the open group suffered from peri-operative complications and the difference between the two groups was significant (9.3% vs 20.0%, p=0.026). The conversion rate for laparoscopic surgery was 13.9%. Patients with gastric cancer can benefit from laparoscopy-assisted operations completed by inexperienced junior surgeons under supervision of expert laparoscopic surgeons.
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Affiliation(s)
- Xing-Mao Zhang
- Department of Gastrointestinal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China E-mail :
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Huang LY, Cui J, Wu CR, Zhang B, Jiang LX, Xian XS, Lin SJ, Xu N, Cao XL, Wang ZH. Endoscopic full-thickness resection and laparoscopic surgery for treatment of gastric stromal tumors. World J Gastroenterol 2014; 20:8253-8259. [PMID: 25009400 PMCID: PMC4081700 DOI: 10.3748/wjg.v20.i25.8253] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 04/09/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the effectiveness of endoscopic full-thickness resection (EFR) and laparoscopic surgery in the treatment of gastric stromal tumors arising from the muscularis propria.
METHODS: Out of 62 gastric stromal tumors arising from the muscularis propria, each > 1.5 cm in diameter, 32 were removed by EFR, and 30 were removed by laparoscopic surgery. The tumor expression of CD34, CD117, Dog-1, S-100, and SMA was assessed immunohistochemically. The operative time, complete resection rate, length of hospital stay, incidence of complications, and recurrence rate were compared between the two groups. Continuous data were compared using independent samples t-tests, and categorical data were compared using χ2 tests.
RESULTS: The 32 gastric stromal tumors treated by EFR and the 30 treated by laparoscopic surgery showed similar operative time [20-155 min (mean, 78.5 ± 30.1 min) vs 50-120 min (mean, 80.9 ± 46.7 min), P > 0.05], complete resection rate (100% vs 93.3%, P > 0.05), and length of hospital stay [4-10 d (mean, 5.9 ± 1.4 d) vs 4-19 d (mean, 8.9 ± 3.2 d), P >0.05]. None of the patients treated by EFR experienced complications, whereas two patients treated by laparoscopy required a conversion to laparotomy, and one patient had postoperative gastroparesis. No recurrences were observed in either group. Immunohistochemical staining showed that of the 62 gastric stromal tumors diagnosed by gastroscopy and endoscopic ultrasound, six were leiomyomas (SMA-positive), one was a schwannoglioma (S-100 positive), and the remaining 55 were stromal tumors.
CONCLUSION: Some gastric stromal tumors arising from the muscularis propria can be completely removed by EFR. EFR could likely replace surgical or laparoscopic procedures for the removal of gastric stromal tumors.
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Koh YX, Chok AY, Zheng HL, Tan CS, Chow PKH, Wong WK, Goh BKP. A systematic review and meta-analysis comparing laparoscopic versus open gastric resections for gastrointestinal stromal tumors of the stomach. Ann Surg Oncol 2013; 20:3549-60. [PMID: 23793362 DOI: 10.1245/s10434-013-3051-1] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study is a systematic review and meta-analysis that compares the short- and long-term outcomes of laparoscopic gastric resection (LR) versus open gastric resection (OR) for gastric gastrointestinal stromal tumors (GISTs). METHODS Comparative studies reporting the outcomes of LR and OR for GIST were reviewed. RESULTS A total of 11 nonrandomized studies reviewed 765 patients: 381 LR and 384 OR. A higher proportion of high-risk tumors and gastrectomies were in the OR compared with LR (odds ratio, 3.348; 95 % CI, 1.248-8.983; p = .016) and (odds ratio, .169; 95 % CI, .090-.315; p < .001), respectively. Intraoperative blood loss was significantly lower in the LR group [weighted mean difference (WMD), -86.508 ml; 95 % CI, -141.184 to -31.831 ml; p < .002]. The LR group was associated with a significantly lower risk of minor complications (odds ratio, .517; 95 % CI, .277-.965; p = .038), a decreased postoperative hospital stay (WMD, -3.421 days; 95 % CI, -4.737 to -2.104 days; p < .001), a shorter time to first flatus (WMD, -1.395 days; 95 % CI, -1.655 to -1.135 days; p < .001), and shorter time for resumption of oral intake (WMD, -1.887 days; 95 % CI, -2.785 to -.989 days; p < .001). There was no statistically significant difference between the two groups with regard to operation time (WMD, 5.731 min; 95 % CI, -15.354-26.815 min; p = .594), rate of major complications (odds ratio, .631; 95 % CI, .202-1.969; p = .428), margin positivity (odds ratio, .501; 95 % CI, .157-1.603; p = .244), local recurrence rate (odds ratio, .629; 95 % CI, .208-1.903; p = .412), recurrence-free survival (RFS) (odds ratio, 1.28; 95 % CI, .705-2.325; p = .417), and overall survival (OS) (odds ratio, 1.879; 95 % CI, .591-5.979; p = .285). CONCLUSIONS LR results in superior short-term postoperative outcomes without compromising oncological safety and long-term oncological outcomes compared with OR.
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Affiliation(s)
- Ye-Xin Koh
- Department of Surgery, Singapore General Hospital, Singapore, Singapore
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Shu ZB, Sun LB, Li JP, Li YC, Ding DY. Laparoscopic versus open resection of gastric gastrointestinal stromal tumors. Chin J Cancer Res 2013; 25:175-82. [PMID: 23592898 DOI: 10.3978/j.issn.1000-9604.2013.02.03] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 02/19/2013] [Indexed: 12/22/2022] Open
Abstract
The aims of this study were to explore whether laparoscopic surgical resections of gastric gastrointestinal stromal tumors (GISTs) would produce better perioperative and similar oncologic outcomes compared with open surgical resection in Chinese patients. Thirty-six gastric GISTs cases were divided into a minimally invasive laparoscopic group and open resection group, depending on the surgical approach that was used. The general preoperative information, operative time, incision length, intraoperative blood loss, postoperative time to first flatulence, postoperative complications, postoperative hospital stay, total hospitalization costs, and such follow-up data as recurrence, metastasis, and mortality rates were compared between two groups. Among the 36 gastric GISTs, 15 received laparoscopic surgical treatment (laparoscopy group, n=15), and 21 received routine open resection treatment (open resection group, n=21). The laparoscopy group and the open resection group showed statistically significant differences (P<0.05) in incision length (7.8±2.3 vs. 16.9±3.8 cm), postoperative time to first flatulence (3.8±1.3 vs. 5.1±2.1 d), postoperative hospitalization time (7.6±2.5 vs. 11.3±3.7 d), and total cost of hospitalization (RMB 28,239±5,521 vs. RMB 23,761±5,362). There were no statistically significant differences (P>0.05) between the laparoscopy group and the open resection group in operative time (147.8±59.3 vs. 139.2±62.1 min) and intraoperative blood loss (149.8±98.9 vs. 154.2±99.3 mL). Both groups had no postoperative complications, no recurrence and metastasis, and no postoperative mortality. There were no statistically significant differences between the two groups in postoperative complications, postoperative recurrence and metastasis, and postoperative mortality. In conclusion, compared with open resection, the laparoscopic resection of gastric GISTs offers the advantages of less trauma, faster recovery, and shorter hospital stay.
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Affiliation(s)
- Zhen-Bo Shu
- Department of Gastrointestinal Surgery, China-Japan Union Hospital, Jilin University, Changchun 130033, China
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