Background Laparoscopic resection of gastric gastrointestinal stromal tumors (GISTs) is technically feasible and associated with favorable outcomes. We compared the clinical efficacy of hand-assisted laparoscopic surgery (HLS) and total laparoscopic surgery (TLS) for gastric GISTs. Methods We retrospectively analyzed the clinical data of 69 consecutive patients diagnosed with a gastric GIST in a tertiary referral teaching hospital from December 2016 to December 2020. Surgical outcomes were compared between two groups. Results Fifty-three patients (TLS group: n = 36; HLS group: n = 17) were included. The mean age was 56.9 and 58.1 years in the TLS and HLS groups, respectively. The maximum tumor margin was significantly shorter in the HLS group than in the TLS group (2.3 ± 0.9. vs. 3.0 ± 0.8 cm; P = 0.004). The operative time of the HLS group was significantly shorter than that of the TLS group (70.6 ± 19.1 min vs. 134.4 ± 53.7 min; P < 0.001). The HLS group had less intraoperative blood loss, a shorter time to first flatus, and a shorter time to fluid diet than the TLS group (P < 0.05). No significant difference was found between the groups in the incidence or severity of complications within 30 days after surgery. Recurrence or metastasis occurred in four cases (HLS group; n = 1; TLS group; n = 3). Conclusions This study demonstrated that compared with TLS, HLS for gastric GISTs has the advantages of simpler operation, shorter operative time, and faster postoperative recovery.

Background: Suppression of the immune microenvironment is a crucial cause of postoperative tumor recurrence. We constructed an immune in ltration classi er based on immunosuppressive indicators to predict recurrence and guide postoperative treatment for gastric cancer (GC). Methods: Immunohistochemical analysis was performed for 825 GC tissues to evaluate immunosuppressive indicators. An immunosuppressive recurrence score (IRS) based on six immunosuppressive indicators was determined using the Lasso Cox method to predict recurrence outcomes. The association between immune in ltration and IRS was assessed using immunohistochemistry and multiplexed immuno uorescence staining. A nomogram predicting recurrence-free survival (RFS) was constructed by integrating IRS and signi cant clinicopathological features using the Cox regression model.Results: The IRS and IRS-based nomogram showed remarkable accuracy and reliability for predicting the recurrence outcome. Moreover, elevated IRS was associated with locoregional recurrence and failure of postoperative adjuvant chemotherapy. We also identi ed that the increased IRS indicated the inhibition of anti-tumor effect of CD8 + tumor-in ltrating lymphocytes (TILs) in the invasive margin (IM). Conclusion: IRS can predict the recurrence outcome of GC patients by comprehensively distinguishing the