Chi Jun-Lin, Xu Mao, Zhang Ming-Ran, Li Yuan, Zhou Zong-Guang
Department of Gastroenterological Surgery, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
State Key Laboratory of Biotherapy, Institute of Digestive Surgery, West China Hospital, Sichuan University, No.1 Ke-Yuan-Si-Lu, Gao-Peng-Da-Dao, Chengdu, 610041, Sichuan, China.
World J Surg. 2017 Sep;41(9):2345-2352. doi: 10.1007/s00268-017-4005-8.
Laparoscopic resection for gastric gastrointestinal stromal tumors (GISTs) is technically feasible, but the long-term effect remains uncertain. This study aims to compare the long-term oncologic outcomes of laparoscopic versus open resection of GISTs by larger cases based on tumor size-location-matched study.
Between 2006 and 2015, 63 consecutive patients with a primary gastric GIST undergoing laparoscopic resection were enrolled in and matched (1:1) to patients undergoing open resection by tumor size and location. Clinical and pathologic parameters and surgical outcomes associated with each surgical type were collected and compared.
The operation time, intraoperative blood loss, return of bowel function and oral intake, nasogastric tube retention time and postoperative stay were all shorter/faster in laparoscopic group than those in open group (P < 0.001). Postoperative complications were comparable except for the higher incidence of abdominal/incision pain in open group (9.52 vs 27%, P = 0.01). There was no statistical difference in recurrence rate (9.52 vs 15.87%, P = 0.29) and long-term recurrence-free survival between the two groups (P = 0.39).
The long-term oncologic outcome of laparoscopic resection of primary gastric GISTs is comparable to that of open procedure, but laparoscopic procedure has the advantage of minimal invasion and is superior in postoperative recovery.
腹腔镜切除胃胃肠道间质瘤(GISTs)在技术上是可行的,但长期效果仍不确定。本研究旨在基于肿瘤大小-位置匹配研究,通过更大样本量比较腹腔镜与开放手术切除GISTs的长期肿瘤学结局。
2006年至2015年期间,连续纳入63例行腹腔镜切除原发性胃GIST的患者,并按肿瘤大小和位置与接受开放手术切除的患者进行1:1匹配。收集并比较与每种手术方式相关的临床和病理参数以及手术结局。
腹腔镜组的手术时间、术中出血量、肠功能恢复和经口进食时间、鼻胃管留置时间及术后住院时间均短于/快于开放组(P < 0.001)。除开放组腹部/切口疼痛发生率较高外(9.52%对27%,P = 0.01),两组术后并发症发生率相当。两组的复发率(9.52%对15.87%,P = 0.29)和长期无复发生存率无统计学差异(P = 0.39)。
腹腔镜切除原发性胃GIST的长期肿瘤学结局与开放手术相当,但腹腔镜手术具有微创优势,术后恢复更佳。