Laparoscopic treatment of gastric GIST: report of 21 cases and literature's review.
BACKGROUND
Although the feasibility of laparoscopic resection of gastric gastrointestinal stromal tumors (GISTs) has been established, various aspects are debated. This paper describes the problems of minimally invasive resection of gastric GISTs and compares this experience with an extensive literature review.


METHODS
Between August 2001 and December 2006, 21 consecutive patients undergoing laparoscopic resection of gastric GISTs were enrolled in a prospective study. A literature review of laparoscopic treatment was performed on Pubmed using keywords GIST and surgery. A comparison with authors' experience with open wedge-segmental resection of GISTs (25 cases from November 1995 to December 2000) was also carried out. Statistical analysis was based on chi-squared test and t Student evaluation.


RESULTS
Twenty-one patients, mean age 50.1 years (range, 34-68 years), were submitted to laparoscopic wedge- segmental gastric resections. Mean tumor size was 4.5 cm (range, 2.0-8.5 cm). Mean operative time was 151 min (range, 52-310 min), the mean blood loss was 101 mL (range, 10-250 mL), and the mean hospital stay was 4.8 days (range 3-7 days). There were no major operative complications or mortalities. All lesions had negative resection margins. At a mean follow-up of 35 months, all patients were disease-free. Morbidity, mortality, length of stay, and oncologic outcomes were comparable to the open surgery retrospective evaluation (p=not significant).


CONCLUSIONS
As found also in the literature review, the laparoscopic resection is safe and effective in treating gastric GISTs. Given these findings as well as the advantages afforded by laparoscopic surgery, a minimally invasive approach should be the preferred surgical treatment in patients with small- and medium-sized gastric GISTs.
Catena
Fausto
F
Transplant, General and Emergency Surgery Department, St Orsola-Malpighi University Hospital, Via Massarenti 9, 40138, Bologna, Italy. fcatena@aosp.bo.it
Di Battista
Monica
M
Fusaroli
Pietro
P
Ansaloni
Luca
L
Di Scioscio
Valerio
V
Santini
Donatella
D
Pantaleo
Maria
M
Biasco
Guido
G
Caletti
Giancarlo
G
Pinna
Antonio
A
D000328:Adult; D000368:Aged; D016099:Endoscopy, Gastrointestinal; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017792:Surgical Stapling; D013536:Suture Techniques; D016896:Treatment Outcome