Abstract
Purpose
The stomach is the most frequent site of gastrointestinal stromal tumor (GIST). Surgery remains the only curative treatment for GIST. Resection needs to ensure tumor free margin without lymphadenectomy. Thus partial gastric resection is the treatment of choice for gastric GIST. This study aims to review clinical characteristics between open and laparoscopic wedge resection group and evaluate safety and efficacy of laparoscopic wedge resection.
Methods
Between 1997 and 2008, 74 consecutive patients undergoing open or laparoscopic wedge resection of gastric GISTs were identified in a retrospectively collected database. Preoperative and postoperative variables were analyzed.
Results
Wedge resection with negative margin was performed in 74 patients. Laparoscopic wedge resection was performed 19 patients. Open wedge resection was performed in 55 patients. Mean tumor size of laparoscopic group was 2.7 cm (range 0.4~6.0) and open group was 4.4 cm (range 0.4~23.0). Mean operation time of laparoscopic group was 150.0 minutes (range 80~240), and open group was 164.6 minutes (range 75~360). Mean hospital stay of laparoscopic group was 7.11 days (range 3~19), and open group was 9.38 days (range 6~20). There were no significant survival differences between groups.
Conclusion
A laparoscopic wedge resection of gastric GIST is associated with short hospitalization and not inferior to open wedge resection in terms of morbidity and mortality. The long-term outcomes between laparoscopic and open wedge resection group in our study were no significant survival differences. Long-term and prospective randomized study should be performed to confirm oncological safety of laparoscopic wedge resection.
Figures and Tables
References
1. Mazur MT, Clark HB. Gastric stromal tumors. Reappraisal of histogenesis. Am J Surg Pathol. 1983. 7:507–519.
2. Seok SH, Kim JM, Bae JM, Kim SW, Kim SW, Song SK, et al. Prognosis of gastrointestinal stromal tumors arising in the stomach and small intestine: a retrospective study of 126 cases from a single institution. Korean J Pathol. 2008. 42:335–343.
3. Miettinen M, Lasota J. Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol. 2006. 23:70–83.
4. Demetri GD, Benjamin RS, Blanke CD, Blay JY, Casali P, Choi H, et al. NCCN Task Force report: management of patients with gastrointestinal stromal tumor (GIST)--update of the NCCN clinical practice guidelines. J Natl Compr Canc Netw. 2007. 5:Suppl 2. S1–S29. quiz S30.
5. Hornick JL, Fletcher CD. The role of KIT in the management of patients with gastrointestinal stromal tumors. Hum Pathol. 2007. 38:679–687.
6. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. 2010. Vol. 2:National Comprehensive Cancer Network.
7. Ronellenfitsch U, Staiger W, Kahler G, Strobel P, Schwarzbach M, Hohenberger P. Perioperative and oncological outcome of laparoscopic resection of gastrointestinal stromal tumour (GIST) of the stomach. Diagn Ther Endosc. 2009. 2009:286138.
8. Yang HK, Park DJ, Lee HJ, Kim HH, Kim WH, Lee KU. Clinicopathologic characteristics of gastrointestinal stromal tumor of the stomach. Hepatogastroenterology. 2008. 55:1925–1930.
9. Huguet KL, Rush RM Jr, Tessier DJ, Schlinkert RT, Hinder RA, Grinberg GG, et al. Laparoscopic gastric gastrointestinal stromal tumor resection: the mayo clinic experience. Arch Surg. 2008. 143:587–590. discussion 91.
10. Novitsky YW, Kercher KW, Sing RF, Heniford BT. Long-term outcomes of laparoscopic resection of gastric gastrointestinal stromal tumors. Ann Surg. 2006. 243:738–745. discussion 45-7.
11. Sexton JA, Pierce RA, Halpin VJ, Eagon JC, Hawkins WG, Linehan DC, et al. Laparoscopic gastric resection for gastrointestinal stromal tumors. Surg Endosc. 2008. 22:2583–2587.
12. Yoon SJ, Lee SH, Lee SM, Park HC, Koh SH, Hong SW, et al. Diagnosis and prognosis of gastrointestinal stromal tumors in the stomach. J Korean Surg Soc. 2005. 68:464–470.