Early experience of laparoscopic resection and comparison with open surgery for gastric gastrointestinal stromal tumor: a multicenter retrospective study

Shin-Hoo Park, Hyuk-Joon Lee, Min-Chan Kim, Jeong-Hwan Yook, Tae-Sung Sohn, Woo-Jin Hyung, Seung-Wan Ryu, Yukinori Kurokawa, Young-Woo Kim, Sang-Uk Han, Hyung-Ho Kim, Do-Joong Park, Wook Kim, Sang-Il Lee, Haruhiko Cho, Gyu-Seok Cho, Jin-Jo Kim, Ki-Han Kim, Moon-Won Yoo, Han-Kwang Yang, Shin-Hoo Park, Hyuk-Joon Lee, Min-Chan Kim, Jeong-Hwan Yook, Tae-Sung Sohn, Woo-Jin Hyung, Seung-Wan Ryu, Yukinori Kurokawa, Young-Woo Kim, Sang-Uk Han, Hyung-Ho Kim, Do-Joong Park, Wook Kim, Sang-Il Lee, Haruhiko Cho, Gyu-Seok Cho, Jin-Jo Kim, Ki-Han Kim, Moon-Won Yoo, Han-Kwang Yang

Abstract

The advantages of laparoscopic resection over open surgery in the treatment of gastric gastrointestinal stromal tumor (GIST) are not conclusive. This study aimed to evaluate the postoperative and oncologic outcome of laparoscopic resection for gastric GIST, compared to open surgery. We retrospectively reviewed the prospectively collected database of 1019 patients with gastric GIST after surgical resection at 13 Korean and 2 Japanese institutions. The surgical and oncologic outcomes were compared between laparoscopic and open group, through 1:1 propensity score matching (PSM). The laparoscopic group (N = 318) had a lower rate of overall complications (3.5% vs. 7.9%, P = 0.024) and wound complications (0.6% vs. 3.1%, P = 0.037), shorter hospitalization days (6.68 ± 4.99 vs. 8.79 ± 6.50, P < 0.001) than the open group (N = 318). The superiority of the laparoscopic approach was also demonstrated in patients with tumors larger than 5 cm, and at unfavorable locations. The recurrence-free survival was not different between the two groups, regardless of tumor size, locational favorableness, and risk classifications. Cox regression analysis revealed that tumor size larger than 5 cm, higher mitotic count, R1 resection, and tumor rupture during surgery were independent risk factors for recurrence. Laparoscopic surgery provides lower rates of complications and shorter hospitalizations for patients with gastric GIST than open surgery.

Conflict of interest statement

The authors declare no competing interests.

© 2022. The Author(s).

Figures

Figure 1
Figure 1
Comparison of disease-free survival between the laparoscopic and open groups. (a) Disease-free survival in all patients, before 1:1 propensity score matching. (b) Disease-free survival in all patients, after 1:1 propensity score matching. (c) Disease-free survival in patients with tumor ≤ 5 cm, after 1:1 propensity score matching. (d) Disease-free survival in patients with tumor > 5 cm, after 1:1 propensity score matching. (e) Disease-free survival in patients with tumor at favorable location, after 1:1 propensity score matching. (f) Disease-free survival in patients with tumor at unfavorable location, after 1:1 propensity score matching. (g) Disease-free survival in patients with very low to intermediate risk by National Institutes of Health classification, after 1:1 propensity score matching. (h) Disease-free survival in patients with high risk by National Institutes of Health classification, after 1:1 propensity score matching.
Figure 2
Figure 2
The flow chart for the patient selection model.

References

    1. Joensuu H, Hohenberger P, Corless CL. Gastrointestinal stromal tumour. Lancet (Lond. Engl.) 2013;382:973–983. doi: 10.1016/s0140-6736(13)60106-3.
    1. Dematteo RP, et al. Tumor mitotic rate, size, and location independently predict recurrence after resection of primary gastrointestinal stromal tumor (GIST) Cancer. 2008;112:608–615. doi: 10.1002/cncr.23199.
    1. Joensuu H, et al. One vs three years of adjuvant imatinib for operable gastrointestinal stromal tumor: A randomized trial. JAMA. 2012;307:1265–1272. doi: 10.1001/jama.2012.347.
    1. Yang HK, et al. Clinicopathologic characteristics of gastrointestinal stromal tumor of the stomach. Hepatogastroenterology. 2008;55:1925–1930.
    1. Bischof DA, et al. Open versus minimally invasive resection of gastric GIST: A multi-institutional analysis of short- and long-term outcomes. Ann. Surg. Oncol. 2014;21:2941–2948. doi: 10.1245/s10434-014-3733-3.
    1. De Vogelaere K, Hoorens A, Haentjens P, Delvaux G. Laparoscopic versus open resection of gastrointestinal stromal tumors of the stomach. Surg. Endosc. 2013;27:1546–1554. doi: 10.1007/s00464-012-2622-8.
    1. Blackstein ME, et al. Gastrointestinal stromal tumours: Consensus statement on diagnosis and treatment. J. Can. Gastroenterol. 2006;20:157–163. doi: 10.1155/2006/434761.
    1. Nilsson B, et al. Gastrointestinal stromal tumors: The incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era—A population-based study in western Sweden. Cancer. 2005;103:821–829. doi: 10.1002/cncr.20862.
    1. Lee HJ, et al. Short-term outcomes of a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy with D2 lymphadenectomy to open distal gastrectomy for locally advanced gastric cancer (KLASS-02-RCT) Ann. Surg. 2019;270:983–991. doi: 10.1097/sla.0000000000003217.
    1. Kim HH, et al. Effect of laparoscopic distal gastrectomy vs open distal gastrectomy on long-term survival among patients with stage I gastric cancer: The KLASS-01 randomized clinical trial. JAMA Oncol. 2019;5:506–513. doi: 10.1001/jamaoncol.2018.6727.
    1. Chen QL, et al. Laparoscopic versus open resection for gastric gastrointestinal stromal tumors: An updated systematic review and meta-analysis. World J. Surg. Oncol. 2014;12:206. doi: 10.1186/1477-7819-12-206.
    1. Xiong H, et al. 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. doi: 10.1016/j.amjsurg.2017.03.042.
    1. Yu M, et al. Meta-analysis on the efficacy and safety of laparoscopic surgery for large gastric gastrointestinal stromal tumors. Am. Surg. 2021;87:450–457. doi: 10.1177/0003134820951482.
    1. Zheng L, Ding W, Zhou D, Lu L, Yao L. Laparoscopic versus open resection for gastric gastrointestinal stromal tumors: A meta-analysis. Am. Surg. 2014;80:48–56. doi: 10.1177/000313481408000124.
    1. Hsiao CY, Yang CY, Lai IR, Chen CN, Lin MT. Laparoscopic resection for large gastric gastrointestinal stromal tumor (GIST): Intermediate follow-up results. Surg. Endosc. 2015;29:868–873. doi: 10.1007/s00464-014-3742-0.
    1. Piessen G, et al. Laparoscopic versus open surgery for gastric gastrointestinal stromal tumors: What is the impact on postoperative outcome and oncologic results? Ann. Surg. 2015;262:831–839. doi: 10.1097/sla.0000000000001488.
    1. Xu C, et al. Retrospective study of laparoscopic versus open gastric resection for gastric gastrointestinal stromal tumors based on the propensity score matching method. Surg. Endosc. 2017;31:374–381. doi: 10.1007/s00464-016-4983-x.
    1. Xiong Z, et al. Laparoscopic versus open surgery for gastric gastrointestinal stromal tumors: A propensity score matching analysis. J. Gastrointest. Surg. Off. J. Soc. Surg. Aliment Tract. 2020;24:1785–1794. doi: 10.1007/s11605-019-04318-6.
    1. Kim MC, et al. Long-term surgical outcome of 1057 gastric GISTs according to 7th UICC/AJCC TNM system: Multicenter observational study from Korea and Japan. Medicine. 2015;94:e1526. doi: 10.1097/md.0000000000001526.
    1. DeMatteo RP, et al. Two hundred gastrointestinal stromal tumors: Recurrence patterns and prognostic factors for survival. Ann. Surg. 2000;231:51–58. doi: 10.1097/00000658-200001000-00008.
    1. Silberhumer GR, et al. Surgery for gastrointestinal stromal tumors of the stomach. J. Gastrointest. Surg. Off. J. Soc. Surg. Aliment. Tract. 2009;13:1213–1219. doi: 10.1007/s11605-009-0872-0.
    1. Yasuda K, et al. Long-term quality of life after laparoscopy-assisted distal gastrectomy for gastric cancer. Surg. Endosc. 2007;21:2150–2153. doi: 10.1007/s00464-007-9322-9.
    1. Kim YW, et al. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: Results of a prospective randomized clinical trial. Ann. Surg. 2008;248:721–727. doi: 10.1097/SLA.0b013e318185e62e.
    1. von Mehren M, et al. Gastrointestinal stromal tumors, version 2.2014. J. Natl. Compr. Cancer Netw. JNCCN. 2014;12:853–862. doi: 10.6004/jnccn.2014.0080.
    1. von Mehren M, et al. Soft tissue sarcoma, version 2.2018, NCCN clinical practice guidelines in oncology. J. Natl. Compr. Cancer Netw. JNCCN. 2018;16:536–563. doi: 10.6004/jnccn.2018.0025.
    1. Huang CM, et al. Can laparoscopic surgery be applied in gastric gastrointestinal stromal tumors located in unfavorable sites? A study based on the NCCN guidelines. Medicine. 2017;96:e6535. doi: 10.1097/md.0000000000006535.
    1. Huguet KL, et al. Laparoscopic gastric gastrointestinal stromal tumor resection: the mayo clinic experience. Arch. Surg. (Chicago, Ill : 1960) 2008;143:587–590. doi: 10.1001/archsurg.143.6.587.
    1. Ma JJ, et al. Laparoscopic gastric resection approaches for gastrointestinal stromal tumors of stomach. Surg. Laparosc. Endosc. percutaneous Tech. 2011;21:101–105. doi: 10.1097/SLE.0b013e3182139546.
    1. Lin J, et al. Laparoscopic versus open gastric resection for larger than 5 cm primary gastric gastrointestinal stromal tumors (GIST): A size-matched comparison. Surg. Endosc. 2014;28:2577–2583. doi: 10.1007/s00464-014-3506-x.
    1. Kim KH, et al. Long term survival results for gastric GIST: Is laparoscopic surgery for large gastric GIST feasible? World J. Surg. Oncol. 2012;10:230. doi: 10.1186/1477-7819-10-230.
    1. Kim JH, Jun KH, Chin HM. Short-term surgical outcomes of laparoscopy-assisted versus totally laparoscopic Billroth-II gastrectomy for gastric cancer: A matched-cohort study. BMC Surg. 2017;17:45. doi: 10.1186/s12893-017-0245-7.
    1. Chi JL, Xu M, Zhang MR, Li Y, Zhou ZG. Laparoscopic versus open resection for gastric gastrointestinal stromal tumors (GISTs): A Size-location-matched case-control study. World J. Surg. 2017;41:2345–2352. doi: 10.1007/s00268-017-4005-8.
    1. Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg. Laparosc. Endosc. 1994;4:146–148.
    1. von Mehren M, Joensuu H. Gastrointestinal stromal tumors. J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol. 2018;36:136–143. doi: 10.1200/jco.2017.74.9705.
    1. Joensuu H, et al. Risk of recurrence of gastrointestinal stromal tumour after surgery: An analysis of pooled population-based cohorts. Lancet Oncol. 2012;13:265–274. doi: 10.1016/s1470-2045(11)70299-6.
    1. Khoo CY, et al. Laparoscopic wedge resection for suspected large (≥5 cm) gastric gastrointestinal stromal tumors. Surg. Endosc. 2017;31:2271–2279. doi: 10.1007/s00464-016-5229-7.
    1. Lee J, Little TD. A practical guide to propensity score analysis for applied clinical research. Behav. Res. Ther. 2017;98:76–90. doi: 10.1016/j.brat.2017.01.005.
    1. Kim W, et al. Korean Laparo-endoscopic Gastrointestinal Surgery Study (KLASS) Group. Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage I gastric cancer: Short-term outcomes from a multicenter randomized controlled trial (KLASS-01) Ann. Surg. 2016;263:28–35. doi: 10.1097/SLA.0000000000001346.
    1. Lee HJ, et al. Korean Laparo-endoscopic Gastrointestinal Surgery Study (KLASS) Group. Short-term outcomes of a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy with D2 lymphadenectomy to open distal gastrectomy for locally advanced gastric cancer (KLASS-02-RCT) Ann. Surg. 2019;270:983–991. doi: 10.1097/SLA.0000000000003217.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever