Comparison between laparoscopic and open surgery for large gastrointestinal stromal tumors: A meta-analysis

Abstract

AIMTo investigate whether laparoscopic surgery is as safe and feasible as open resection for patients with larger gastrointestinal stromal tumors (GISTs) (≥ 5 cm).METHODSA 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 quality of the studies was assessed by the Newcastle-Ottawa Quality Assessment Scale. The tumor size, operation time, blood loss, postoperative hospital stay, complication rate, and disease-free survival rate were assessed. The software Stata (version 12.0) was used for the meta-analysis.RESULTSFive clinical trials comprising 209 patients with GISTs of similar larger sizes were evaluated. The pooled analysis of 100 patients in the laparoscopic resection group and 109 patients in the open resection group demonstrated that laparoscopic surgery was significantly associated with a shorter postoperative hospital stay (P < 0.001) and less blood loss (P = 0.002). 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.CONCLUSIONOur findings revealed that for patients with large GISTs of comparable sizes, laparoscopic surgery did not significantly influence the operation factors or clinical outcomes compared with open surgery. This suggests that laparoscopic resection is as acceptable as open surgery for treatment of large gastric GISTs.

Long-term outcomes of endoscopic resection for small (≤ 4.0 cm) gastric gastrointestinal stromal tumors originating from the muscularis propria layer

“…Some surgeons have posited that ER can result in insufficient margins that would likely increase the risk of tumor recurrence or implantation metastasis. Thus, laparoscopic wedge resection (LWR) is still recommended for treating small gastric MP- GISTs[ 7 - 9 ]. Nevertheless, LWR is associated with a number of serious long-term complications.…”

“…Nevertheless, LWR is associated with a number of serious long-term complications. Especially when the tumor is located near or in the gastric cardia or pylorus, resection of the gastric cardia or pylorus might lead to irreparable damage to the cardioesophageal sphincter or pylori sphincter, leaving patients prone to certain diseases associated with digestive fluid reflux[ 7 , 9 , 10 ].…”

Endoscopic Removal of Gastrointestinal Stromal Tumors in the Stomach: A Single-Center Experience

“…However, it is sometimes difficult to determine the appropriate resection line, and excessive normal tissues may be removed with a laparoscope as these tumors are covered by the normal gastric wall [14]. Moreover, a postoperative stricture may be easily formed after laparoscopic surgery when lesions are located near or in the gastric cardia or pylorus [17]. In contrast, endoscopic treatment provides a clearer operative view to identify a precise resection area without needless extensive excision.…”

Recent Progress and Challenges in the Diagnosis and Treatment of Gastrointestinal Stromal Tumors

“…Initially, laparoscopic surgery is predominantly performed for GISTs that are smaller than 5 cm, but currently, it is applied to GISTs larger than 5 cm. Several retrospective studies and their meta-analyses suggest that laparoscopic surgery for large GISTs shows similar operation times, and less blood loss, postoperative morbidity, and shorter in-hospital days than open surgery [81][82][83]. Long-term oncologic outcomes in terms of disease-free survival (DFS) and overall survival (OS) are similar between the two.…”