Cui JX, Gao YH, Xi HQ, Cai AZ, Zhang KC, Li JY, Wei B, Chen L. Comparison between laparoscopic and open surgery for large gastrointestinal stromal tumors: A meta-analysis. World J Gastrointest Oncol 2018; 10(1): 48-55 [PMID: 29375748 DOI: 10.4251/wjgo.v10.i1.48]
Corresponding Author of This Article
Dr. Lin Chen, MD, PhD, Professor, Department of General Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China. chenlin@301hospital.com.cn
Research Domain of This Article
Oncology
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
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/
World J Gastrointest Oncol. Jan 15, 2018; 10(1): 48-55 Published online Jan 15, 2018. doi: 10.4251/wjgo.v10.i1.48
Comparison between laparoscopic and open surgery for large gastrointestinal stromal tumors: A meta-analysis
Jian-Xin Cui, Yun-He Gao, Hong-Qing Xi, Ai-Zhen Cai, Ke-Cheng Zhang, Ji-Yang Li, Bo Wei, Lin Chen
Jian-Xin Cui, Yun-He Gao, Hong-Qing Xi, Ai-Zhen Cai, Ke-Cheng Zhang, Ji-Yang Li, Bo Wei, Lin Chen, Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Cui JX, Gao YH and Xi HQ contributed equally to this work; Wei B and Chen L conceived the project; Cui JX and Gao YH independently searched references and took charge of data extraction and statistical analysis; Xi HQ searched references and extracted the parameters from each study; Cai AZ, Zhang KC and Li JY participated in the manuscript revision; all authors read and approved the final manuscript.
Supported by National Program on Key Basic Research Project of China, No. 2014CBA02002; National Key Research and Development Plan, No. 2016YFC0905302; National Natural Science Foundation of China, Nos. 81672319 and 81602507; and Beijing Municipal Science and Technology Project, No. D131100005313010.
Conflict-of-interest statement: This work was presented as an e-poster at the 12th International Gastric Cancer Congress (IGCC), April 20-23, 2017. We have no financial relationship 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: Dr. Lin Chen, MD, PhD, Professor, Department of General Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China. chenlin@301hospital.com.cn
Telephone: +86-10-66938128 Fax: +86-10-66938128
Received: October 23, 2017 Peer-review started: October 24, 2017 First decision: November 23, 2017 Revised: December 4, 2017 Accepted: December 6, 2017 Article in press: December 6, 2017 Published online: January 15, 2018 Processing time: 80 Days and 18.7 Hours
ARTICLE HIGHLIGHTS
Research background
Laparoscopic resection of relatively small gastric gastrointestinal stromal tumors (GISTs) is currently well-accepted and has been proven as safe and feasible as traditional open surgery. However, whether laparoscopic resection is also effective and feasible for treatment of larger gastric GISTs (> 5 cm) remains unknown.
Research motivation
The authors aimed to explore whether laparoscopic resection is also effective and feasible for treatment of larger gastric GISTs (> 5 cm), just as the same situation in smaller GISTs.
Research objectives
Laparoscopic resection for small GISTs is now well-accepted. However, whether laparoscopic surgery is as safe and feasible as open resection for patients with larger GISTs (≥ 5 cm) remains controversial.
Research methods
A systematic search of PubMed, EMBASE, Web of Science and the Cochrane Library database was performed. Relevant studies of laparoscopic and open surgery for GISTs of > 5 cm published before December 2016 were identified from these databases. The meta-analysis was performed using Stata (version 12.0) applying weighted mean differences for continuous variables, odds ratios for dichotomous variables, and hazard ratios for time-to-event variables.
Research results
In terms of operative and oncological factors, our research demonstrated that laparoscopic surgery was significantly associated with a shorter postoperative hospital stay (P < 0.001) and less blood loss (P = 0.002) in resecting larger GISTs. Moreover, there were no statistically significant differences in the operation time (P = 0.38), postoperative complication rate (P = 0.88), or disease-free survival rate (P = 0.20) between two groups.
Research conclusion
This research stands as the first meta-analysis focusing on this specific type of GISTs. The meta-analysis has demonstrated that laparoscopic surgery is as safe and feasible as open surgery for resection of larger GISTs (> 5 cm, mainly 5-10 cm). Moreover, laparoscopic surgery might offer the advantage of faster recovery and less trauma over open surgery in patients with GISTs.
Research perspectives
Laparoscopic resection is as acceptable as open surgery for treatment of large gastric GISTs.
