Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, Hubei Province, China.
J Gastrointest Surg. 2020 Aug;24(8):1785-1794. doi: 10.1007/s11605-019-04318-6. Epub 2019 Jul 16.
Surgery is the first choice for the treatment of gastric gastrointestinal stromal tumors (GISTs). With the development of new instruments and techniques, the popularity of laparoscopic resection of GISTs has increased rapidly. Previous studies on the advantages of laparoscopic resection over open surgery are generally limited by methodology or data capacity. This study evaluated the efficacy of laparoscopic resection and open surgery in gastric GISTs using the propensity score matching (PSM) method.
Between January 2005 and December 2017, 1027 patients were diagnosed with primary GIST at our institution. Among them, 548 patients were enrolled in this study. Standard demographic and clinicopathological data were collected from our database. Selection bias was eliminated using the PSM methods.
After PSM, 256 cases involved in the comparison (128 laparoscopic (LAP) vs. 128 open surgery (OPEN)) were randomly matched (1:1) by age, sex, body mass index, hypertension, diabetes, heart disease, year of surgery, tumor location, tumor size, mitotic rate, and treatment with adjuvant tyrosine kinase inhibitors. The LAP group was superior to the OPEN group in blood loss (χ = 6.048, P = 0.049), time to first flatus (49.41 ± 7.56 vs. 71.31 ± 4.87 h, P < 0.001), and hospital stay (10.21 ± 6.05 vs. 12.56 ± 5.43 days, P = 0.001). No significant differences were seen in either the relapse-free survival or overall survival between the LAP and OPEN groups. In tumors located in favorable locations, the LAP group showed less blood loss (P = 0.008) and less multivisceral resection (17.8% vs. 5.5%, P = 0.02).
Laparoscopic resection for gastric GISTs is associated with improved surgical outcomes and postoperative courses and comparable oncological outcomes, regardless of favorable or unfavorable tumor location.
手术是治疗胃胃肠道间质瘤（GIST）的首选方法。随着新仪器和技术的发展，腹腔镜 GIST 切除术的普及迅速增加。以前关于腹腔镜切除术优于开放性手术的优势的研究通常受到方法学或数据容量的限制。本研究使用倾向评分匹配（PSM）方法评估腹腔镜切除术和开放性手术在胃 GIST 中的疗效。
2005 年 1 月至 2017 年 12 月，我院诊断出 1027 例原发性 GIST 患者。其中，548 例患者纳入本研究。从我们的数据库中收集标准人口统计学和临床病理学数据。使用 PSM 方法消除选择偏倚。
PSM 后，将 256 例比较（128 例腹腔镜（LAP）与 128 例开放性手术（OPEN））随机匹配（1:1），按年龄、性别、体重指数、高血压、糖尿病、心脏病、手术年份、肿瘤位置、肿瘤大小、有丝分裂率和辅助酪氨酸激酶抑制剂治疗进行匹配。LAP 组的出血量（χ=6.048，P=0.049）、首次排气时间（49.41±7.56 与 71.31±4.87 h，P<0.001）和住院时间（10.21±6.05 与 12.56±5.43 d，P=0.001）优于 OPEN 组。LAP 组和 OPEN 组的无复发生存率和总生存率无显著差异。在位于有利位置的肿瘤中，LAP 组出血量较少（P=0.008），多脏器切除较少（17.8%与 5.5%，P=0.02）。
无论肿瘤位置有利还是不利，腹腔镜切除胃 GIST 与改善手术结果和术后过程以及相似的肿瘤学结果相关。
