Published online Jan 15, 2018. doi: 10.4251/wjgo.v10.i1.48
Peer-review started: October 24, 2017
First decision: November 23, 2017
Revised: December 4, 2017
Accepted: December 6, 2017
Article in press: December 6, 2017
Published online: January 15, 2018
Laparoscopic resection of relatively small gastric gastrointestinal stromal tumors (GISTs) is currently well-accepted and has been proven as safe and feasible as traditional open surgery. However, whether laparoscopic resection is also effective and feasible for treatment of larger gastric GISTs (> 5 cm) remains unknown.
The authors aimed to explore whether laparoscopic resection is also effective and feasible for treatment of larger gastric GISTs (> 5 cm), just as the same situation in smaller GISTs.
Laparoscopic resection for small GISTs is now well-accepted. However, whether laparoscopic surgery is as safe and feasible as open resection for patients with larger GISTs (≥ 5 cm) remains controversial.
A systematic search of PubMed, EMBASE, Web of Science and the Cochrane Library database was performed. Relevant studies of laparoscopic and open surgery for GISTs of > 5 cm published before December 2016 were identified from these databases. The meta-analysis was performed using Stata (version 12.0) applying weighted mean differences for continuous variables, odds ratios for dichotomous variables, and hazard ratios for time-to-event variables.
In terms of operative and oncological factors, our research demonstrated that laparoscopic surgery was significantly associated with a shorter postoperative hospital stay (P < 0.001) and less blood loss (P = 0.002) in resecting larger GISTs. Moreover, there were no statistically significant differences in the operation time (P = 0.38), postoperative complication rate (P = 0.88), or disease-free survival rate (P = 0.20) between two groups.
This research stands as the first meta-analysis focusing on this specific type of GISTs. The meta-analysis has demonstrated that laparoscopic surgery is as safe and feasible as open surgery for resection of larger GISTs (> 5 cm, mainly 5-10 cm). Moreover, laparoscopic surgery might offer the advantage of faster recovery and less trauma over open surgery in patients with GISTs.
Laparoscopic resection is as acceptable as open surgery for treatment of large gastric GISTs.