Department of Surgery, National Taiwan University Biomedical Park Hospital, Hsinchu, Taiwan.
Department of Surgery, Fu-Jen Catholic University Hospital, New Taipei City, Taiwan.
Surg Endosc. 2023 Mar;37(3):2021-2028. doi: 10.1007/s00464-022-09693-x. Epub 2022 Oct 25.
The resection of large gastric gastrointestinal stromal tumors (GISTs) by laparoscopic has been controversial. Extending from our prior study, the long-term oncological outcome of laparoscopic resection of large (5-8 cm) gastric GISTs was reported.
From 2002 to 2018, a consecutive 66 patients with gastric GISTs of 5-8 cm were treated at National Taiwan University Hospital. Among them, 30 patients received open surgery, and 36 received laparoscopic surgery. The clinicopathological data, peri-operative and oncological outcomes were compared between groups.
The clinical demographics including sex, age, BMI, tumor locations and ratio of wedge resection were similar between groups. The mean tumor size was 6.0 ± 0.83 cm versus 6.3 ± 1.07 cm (Open vs. Laparoscopic, p = 0.3). The operation time, blood loss, and post-operative complications, were also similar. The mean hospital stay was shorter in the laparoscopic group (8.8 ± 2.5 days) than in the open group (12.0 ± 8.9 days), though not significantly different. The median follow-up time was 108 ± 58 months (97 ± 50 in laparoscopic group; 122 ± 64 in open group). All except three patients remain disease-free. One in the open group and two in the laparoscopic group had recurrence of tumor, and they were stable of disease under Imatinib treatment. Eight patients died in non-GIST causes during follow-up. The 5-year recurrence-free survival were 100% for the open and 94.2% for the laparoscopic group (p = 0.2).
Our data showed that laparoscopic surgery for gastric GIST between 5 and 8 cm was safe and oncologically feasible.
腹腔镜下切除大型胃胃肠道间质瘤（GIST）一直存在争议。在我们之前的研究中，报告了腹腔镜切除大型（5-8cm）胃 GIST 的长期肿瘤学结果。
从 2002 年到 2018 年，台湾大学医院连续治疗了 66 例胃 GIST 大小为 5-8cm 的患者。其中，30 例患者接受了开放手术，36 例患者接受了腹腔镜手术。比较了两组患者的临床病理资料、围手术期和肿瘤学结果。
两组患者的临床人口统计学资料（性别、年龄、BMI、肿瘤位置和楔形切除比例）相似。肿瘤平均大小为 6.0±0.83cm 与 6.3±1.07cm（开放组与腹腔镜组，p=0.3）。手术时间、出血量和术后并发症也相似。腹腔镜组的平均住院时间（8.8±2.5 天）短于开放组（12.0±8.9 天），但无统计学差异。中位随访时间为 108±58 个月（腹腔镜组 97±50 个月；开放组 122±64 个月）。除 3 例患者外，所有患者均无疾病。开放组和腹腔镜组各有 1 例患者肿瘤复发，在接受伊马替尼治疗后疾病稳定。8 例患者在随访期间死于非 GIST 原因。开放组和腹腔镜组的 5 年无复发生存率分别为 100%和 94.2%（p=0.2）。
我们的数据表明，腹腔镜手术治疗 5-8cm 的胃 GIST 是安全且具有肿瘤学可行性的。
