Wakamatsu Kotaro, Lo Menzo Emanuele, Szomstein Samuel, Seto Yasuyuki, Chalikonda Sricharan, Rosenthal Raul J
1 Section of Minimally Invasive and Endoscopic Surgery, Cleveland Clinic Florida, The Bariatric and Metabolic Institute , Weston, Florida.
2 Department of Gastrointestinal Surgery, The University of Tokyo , Tokyo, Japan .
J Laparoendosc Adv Surg Tech A. 2018 May;28(5):569-573. doi: 10.1089/lap.2017.0564. Epub 2018 Mar 16.
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Complete surgical resection of localized GISTs is the only chance of cure for patients. Laparoscopic resections (LAP) have been widely accepted as a reasonable approach to treat gastric GISTs. The current study compares operative outcomes of laparoscopic and open resection of gastric GISTs.
We retrospectively reviewed patients with primary gastric GISTs who underwent surgical resection between 2003 and 2015.
Of a total of 89 patients, 24 (27%) patients underwent open resection (OPEN), and 65 (73%) underwent LAP. LAP or OPEN did not differ with respect to gender, body mass index, and age. Median blood loss was significantly lower in LAP than in OPEN resection (32.5 mL versus 100 mL, P < .01). Both tumor location and median operative time were comparable between LAP and OPEN (108 versus 108 min, P = .93). Median tumor size in OPEN was significantly larger than LAP tumors (6.5 versus 3.8 cm, P < .01). LAP resection yielded a shorter hospital stay (3.0 versus 6.0 days P < .01) and lower 30-day readmission rate (17% versus 0%; P < .01). Complication rates were 9% after LAP and 12% after OPEN (P = .652). Two patients in each group died during the study period. Kaplan-Meier analysis for overall survival showed no significant difference between LAP and OPEN (P = .23).
LAP of gastric GISTs resulted in similar operative time and survival rate, but shorter hospital stay compared with open resection. Consequently, whenever possible, the laparoscopic approach should be preferably used for treatment of gastric GISTs. However, advanced tumor stage might dictate the need for open procedure with expected worse results.
胃肠道间质瘤（GISTs）是胃肠道最常见的间叶组织肿瘤。对局限性GISTs进行完整的手术切除是患者唯一的治愈机会。腹腔镜切除术（LAP）已被广泛认为是治疗胃GISTs的合理方法。本研究比较了腹腔镜和开放手术切除胃GISTs的手术效果。
我们回顾性分析了2003年至2015年间接受手术切除的原发性胃GISTs患者。
在总共89例患者中，24例（27%）接受了开放手术切除（OPEN），65例（73%）接受了腹腔镜手术切除（LAP）。LAP组和OPEN组在性别、体重指数和年龄方面无差异。LAP组术中失血中位数明显低于OPEN组（32.5 mL对100 mL，P < 0.01）。LAP组和OPEN组的肿瘤位置和手术时间中位数相当（108分钟对108分钟，P = 0.93）。OPEN组肿瘤大小中位数明显大于LAP组（6.5 cm对3.8 cm，P < 0.01）。LAP切除术住院时间更短（3.0天对6.0天，P < 0.01），30天再入院率更低（17%对0%；P < 0.01）。LAP组并发症发生率为9%，OPEN组为12%（P = 0.652）。每组各有2例患者在研究期间死亡。Kaplan-Meier总体生存分析显示LAP组和OPEN组之间无显著差异（P = 0.23）。
胃GISTs的腹腔镜手术切除与开放手术切除的手术时间和生存率相似，但住院时间更短。因此，只要有可能，腹腔镜手术应优先用于治疗胃GISTs。然而，肿瘤晚期可能需要进行开放手术，且预期效果较差。
