Dhawal Sharma, Chittawadagi Bhushan, Cumar Bharath, Kumar Saravana, Palanivelu Chinnusamy
Division of Upper GI Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India.
J Minim Access Surg. 2020 Oct-Dec;16(4):348-354. doi: 10.4103/jmas.JMAS_311_18.
Gastric gastrointestinal stromal tumours (GISTs) are rare neoplasms that require excision for cure. Although the feasibility of laparoscopic resection of smaller gastric GIST has been established, the feasibility and long-term efficacy of these techniques are unclear in larger lesions. This study is done to assess the feasibility of the laparoscopic resection of gastric GISTs and their long-term outcomes.
Patients who underwent laparoscopic resection of gastric GISTs were identified in a prospectively collected database. Outcome measures included patient demographics, operative findings, morbidity and histopathologic characteristics of the tumour. Patient and tumour characteristics were analysed to identify risk factors for tumour recurrence.
There were 42 patients with a mean age of 56.7 years and had a mean tumour size was 4.5 ± 2.7 cm. Laparoscopic wedge resection was the most common procedure done. There were no major perioperative complications or mortalities. All lesions had negative resection margins. At a mean follow-up of 48 months, 36/39 (92.3%) patients were disease free and 3/39 (7.6%) had progressive disease. Univariate analysis showed that there was a statistically significant association of disease progression with tumour size, high mitotic index, tumour ulceration and tumour necrosis. The presence of >10 mitotic figures/50 high-power field was an independent predictor of disease progression.
Our study establishes laparoscopic resection is feasible and safe in treating gastric GISTs for tumours >5 cm size. The long-term disease-free survival in our study shows acceptable oncological results in comparison to historical open resections.
胃胃肠道间质瘤（GIST）是一种罕见的肿瘤，需要通过切除来治愈。虽然腹腔镜切除较小胃GIST的可行性已得到证实，但这些技术在较大病变中的可行性和长期疗效尚不清楚。本研究旨在评估腹腔镜切除胃GIST的可行性及其长期疗效。
在一个前瞻性收集的数据库中识别接受腹腔镜切除胃GIST的患者。结果指标包括患者人口统计学、手术发现、发病率和肿瘤的组织病理学特征。分析患者和肿瘤特征以确定肿瘤复发的危险因素。
42例患者，平均年龄56.7岁，平均肿瘤大小为4.5±2.7cm。腹腔镜楔形切除术是最常见的手术方式。无围手术期重大并发症或死亡。所有病变切缘均为阴性。平均随访48个月时，39例患者中有36例（92.3%）无疾病，3例（7.6%）病情进展。单因素分析显示，疾病进展与肿瘤大小、高有丝分裂指数、肿瘤溃疡和肿瘤坏死之间存在统计学显著关联。每50个高倍视野中有>10个有丝分裂象是疾病进展的独立预测因素。
我们的研究表明，腹腔镜切除对于大小>5cm的胃GIST是可行且安全的。与既往开放手术相比，我们研究中的长期无病生存率显示出可接受的肿瘤学结果。
