Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2017; 23(19): 3522-3529
Published online May 21, 2017. doi: 10.3748/wjg.v23.i19.3522
Laparoscopic management of gastric gastrointestinal stromal tumors: A retrospective 10-year single-center experience
Guan-Qun Liao, Tao Chen, Xiao-Long Qi, Yan-Feng Hu, Hao Liu, Jiang Yu, Guo-Xin Li
Guan-Qun Liao, Tao Chen, Xiao-Long Qi, Yan-Feng Hu, Hao Liu, Jiang Yu, Guo-Xin Li, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Guan-Qun Liao, Department of General Surgery, Foshan Hospital Affiliated to Southern Medical University, Foshan 528000, Guangdong Province, China
Author contributions: Liao GQ and Chen T contributed equally to this work in the design of the study and preparation of the article and should be considered co-first authors; Liao GQ, Chen T, Liu H and Li GX contributed to study conception and design; Chen T, Qi XL, Hu YF, Liu H, Yu J and Li GX contributed to data acquisition, data analysis and interpretation, and writing of the article; Liao GQ, Liu H, Yu J and Li GX contributed to editing, reviewing and final approval of the article.
Institutional review board statement: The study was reviewed and approved by the Science and Research Office of Nanfang Hospital (Guangzhou).
Conflict-of-interest statement: All authors have no conflicts of interest or financial ties to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Guo-Xin Li, MD, PhD, FRCS, Department of General Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou 510515, Guangdong Province, China. gzliguoxin@163.com
Telephone: +86-20-61641681 Fax: +86-20-62787626
Received: February 4, 2017
Peer-review started: February 8, 2017
First decision: March 3, 2017
Revised: March 7, 2017
Accepted: March 15, 2017
Article in press: March 15, 2017
Published online: May 21, 2017
Abstract
AIM

To determine the feasibility, safety, and oncological outcome of laparoscopic resection of gastric gastrointestinal stromal tumors (GISTs) based on favorable or unfavorable location.

METHODS

Our hospital database included 207 patients who underwent laparoscopic removal of gastric GISTs from January 2004 to September 2015. Patient demographics, clinical presentation, surgery, histopathology, postoperative course, and oncological outcomes were reviewed and analyzed.

RESULTS

Gastric GIST in favorable locations was present in 81/207 (39.1%) cases, and in unfavorable locations in 126/207 (60.9%) cases. Overall mean tumor size was 3.28 ± 1.82 cm. No conversions occurred, and complete R0 resection was achieved in 207 (100%) cases. There were three incidences of iatrogenic tumor rupture. The feasibility and safety of laparoscopic surgery were comparable in both groups with no statistical difference between unfavorable and favorable location groups, respectively: for operative time: 83.86 ± 44.41 vs 80.77 ± 36.46 min, P = 0.627; conversion rate: 0% vs 0%; estimated blood loss: 27.74 ± 45.2 vs 29.59 ± 41.18 mL, P = 0.780; tumor rupture during surgery: 0.90% vs 2.82%, P = 0.322; or postoperative complications: 3.74% vs 7.04%, P = 0.325. The follow-up period recurrence rate was 1.89% with no significant differences between the two groups (3.03% vs 0%, P = 0.447). Overall 5-year survival rate was 98.76% and survival rates were similar between the two groups: 98.99% vs 98.39%, P = 0.623 (unfavorable vs favorable, respectively).

CONCLUSION

The laparoscopic approach for gastric GISTs is safe and feasible with well-accepted oncological surgical outcomes. Strategies for laparoscopic resection should be selected according to the location and size of the tumor. Laparoscopic treatment of gastric GISTs in unfavorable locations should not be restricted in gastrointestinal centers.

Keywords: Laparoscopic, Gastrointestinal stromal tumors, Gastrectomy, Minimally invasive surgery

Core tip: In most guidelines laparoscopic surgery is suggested only for gastrointestinal stromal tumors (GISTs) in favorable locations, such as those in the greater curvature or anterior wall of the stomach. The feasibility, safety and oncological outcome of this technique for GISTs in unfavorable locations remain unclear. We aimed to determine the feasibility, safety, and oncological outcome of laparoscopic resection of gastric GISTs based on different location. To our knowledge, this retrospective study includes the largest series of patients with gastric GISTs treated with laparoscopic resection at a single center. We also used and describe three relatively new laparoscopic surgical techniques for GISTs.