Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 7, 2017; 23(25): 4595-4603
Published online Jul 7, 2017. doi: 10.3748/wjg.v23.i25.4595
Comparison of short- and long-term outcomes of laparoscopic vs open resection for gastric gastrointestinal stromal tumors
Xin Ye, Wei-Ming Kang, Jian-Chun Yu, Zhi-Qiang Ma, Zhi-Gang Xue
Xin Ye, Wei-Ming Kang, Jian-Chun Yu, Zhi-Qiang Ma, Zhi-Gang Xue, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
Author contributions: Ye X and Kang WM contributed equally to this work; Ye X, Kang WM and Yu JC designed the research; Ye X, Kang WM and Yu JC performed the research; Ma ZQ and Xue ZG analyzed the data; Ye X, Kang WM and Xue ZG wrote the paper.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jian-Chun Yu, MD, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No. 1 Shuai Fu Yuan, Dongcheng District, Beijing 100730, China. yu-jch@163.com
Telephone: +86-10-69152213 Fax: +86-10-69152213
Received: March 23, 2017
Peer-review started: March 26, 2017
First decision: April 7, 2017
Revised: April 10, 2017
Accepted: June 1, 2017
Article in press: June 1, 2017
Published online: July 7, 2017
Abstract
AIM

To compare the short- and long-term outcomes of laparoscopic (LR) vs open resection (OR) for gastric gastrointestinal stromal tumors (gGISTs).

METHODS

In total, 301 consecutive patients undergoing LR or OR for pathologically confirmed gGISTs from 2005 to 2014 were enrolled in this retrospective study. After exclusion of 77 patients, 224 eligible patients were enrolled (122 undergoing LR and 102 undergoing OR). The demographic, clinicopathologic, and survival data of all patients were collected. The intraoperative, postoperative, and long-term oncologic outcomes were compared between the LR and OR groups following the propensity score matching to balance the measured covariates between the two groups.

RESULTS

After 1:1 propensity score matching for the set of covariates including age, sex, body mass index, American Society of Anesthesiology score, tumor location, tumor size, surgical procedures, mitotic count, and risk stratification, 80 patients in each group were included in the final analysis. The baseline parameters of the two groups were comparable after matching. The LR group was significantly superior to the OR group with respect to the operative time, intraoperative blood loss, postoperative first flatus, time to oral intake, and postoperative hospital stay (P < 0.05). No differences in perioperative blood transfusion or the incidence of postoperative complications were observed between the two groups (P > 0.05). No significant difference was found in postoperative adjuvant therapy (P = 0.587). The mean follow-up time was 35.30 ± 26.02 (range, 4-102) mo in the LR group and 40.99 ± 25.07 (range, 4-122) mo in the OR group with no significant difference (P = 0.161). Survival analysis showed no significant difference in the disease-free survival time or overall survival time between the two groups (P > 0.05).

CONCLUSION

Laparoscopic surgery for gGISTs is superior to open surgery with respect to intraoperative parameters and postoperative outcomes without compromising long-term oncological outcomes.

Keywords: Gastric gastrointestinal stromal tumor, Laparoscopic surgery, Open surgery, Clinical outcome, Prognosis

Core tip: Surgical treatment is the gold standard for gastric gastrointestinal stromal tumors (gGISTs). Increasingly more surgeons are performing laparoscopic resection (LR) to treat gGISTs due to the development and superiority of laparoscopic technology. The efficacy and safety of LR remain unconfirmed and more high-level clinical evidence is required. This study retrospectively compared the short- and long-term outcomes of LR vs open resection (OR) for gGISTs using propensity score matching to adjust for confounding variables in the baseline data and found that LR is superior to OR with respect to intraoperative parameters and postoperative recovery outcomes without compromising long-term oncological outcomes.