Division of General Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Division of General Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
J Am Coll Surg. 2014 Mar;218(3):367-73. doi: 10.1016/j.jamcollsurg.2013.11.029. Epub 2013 Dec 2.
Complete curative resection remains the treatment of choice for nonmetastatic gastrointestinal stromal tumors (GISTs). The safety and feasibility of laparoscopy in the treatment of this disease has been shown, however, the long-term oncologic outcomes of this technique remain unclear.
An ongoing prospectively maintained database including all laparoscopically resected gastric and small bowel GISTs (n = 116) at Mount Sinai Medical Center from July 1999 to December 2011 was retrospectively analyzed. Recurrence and survival outcomes were calculated using the Kaplan-Meier method and compared with log-rank test.
Tumors were of gastric (77.6%) and small bowel (22.4%) origins. Overall mean tumor size was 4.0 cm (±2.7 cm) and R0 resection was achieved in 113 (97.4%) cases. Overall perioperative complication rate was 14.7%, with a reoperative rate of 4.3% at 90 days. When comparing gastric with small bowel GISTs, a more acute presentation requiring emergent resections was noted in patients with small bowel GISTs (p = 008). However tumor size, operative data, and perioperative outcomes were comparable in both groups (p = NS). At a median follow-up of 56.4 months (range 0.1 to 162.4 months), recurrence rate was 7.8% and comparable in both gastric and small bowel GISTs (p = NS). Risk factors for recurrence on univariate analysis were presence of ulceration/necrosis (p < 0.001) and tumor size >5 cm (p = 0.05). Overall 10-year survival rate was 90.8%. Gastric and small bowel overall survival rates were similar (90.7% vs 91.3%, respectively). Overall 10-year disease-free survival was 80.0% (84.3% gastric vs 71.6% small bowel; p = NS).
Our series demonstrates the safety and feasibility of laparoscopy in patients undergoing resection of small bowel and gastric GISTs. Comparable long-term oncologic outcomes with a 10-year survival of 90.8% were achieved.
对于非转移性胃肠道间质瘤（GIST），完整的治愈性切除术仍然是首选治疗方法。腹腔镜治疗这种疾病的安全性和可行性已经得到证实，然而，这种技术的长期肿瘤学结果尚不清楚。
回顾性分析了 1999 年 7 月至 2011 年 12 月期间西奈山医疗中心所有腹腔镜切除的胃和小肠 GIST（n=116）的前瞻性维护数据库。使用 Kaplan-Meier 方法计算复发和生存结果，并使用对数秩检验进行比较。
肿瘤来源于胃（77.6%）和小肠（22.4%）。总体平均肿瘤大小为 4.0cm（±2.7cm），113 例（97.4%）达到 R0 切除。总体围手术期并发症发生率为 14.7%，90 天内再次手术率为 4.3%。比较胃 GIST 和小肠 GIST，小肠 GIST 患者的表现更为急性，需要紧急切除（p=0.08）。然而，两组的肿瘤大小、手术数据和围手术期结果相似（p=NS）。在中位随访 56.4 个月（范围 0.1 至 162.4 个月）时，复发率为 7.8%，在胃 GIST 和小肠 GIST 中相似（p=NS）。单因素分析中，复发的危险因素包括溃疡/坏死（p<0.001）和肿瘤大小>5cm（p=0.05）。总体 10 年生存率为 90.8%。胃和小肠的总体生存率相似（分别为 90.7%和 91.3%）。总体 10 年无病生存率为 80.0%（胃为 84.3%，小肠为 71.6%；p=NS）。
我们的系列研究表明，腹腔镜在胃和小肠 GIST 患者的切除中是安全可行的。实现了可比较的长期肿瘤学结果，10 年生存率为 90.8%。
