Impact of the introduction of laparoscopic wedge resection as a surgical option for suspected small/medium-sized gastrointestinal stromal tumors of the stomach on perioperative and oncologic outcomes.
BACKGROUND
The present study is designed to determine the feasibility and impact of the introduction of laparoscopic wedge resection as a surgical option for the treatment of suspected small/medium-sized (<7 cm) gastric gastrointestinal stromal tumors (GISTs).


METHODS
The study involved a retrospective review of 53 consecutive patients who underwent laparoscopic or open wedge resection of a suspected gastric GIST. It was divided into two consecutive time periods wherein laparoscopic resection was a surgical option only in the latter period. Comparisons were made between the outcomes of patients who underwent laparoscopic versus open wedge resection and the outcomes of patients treated during the two consecutive time periods (to determine the impact of the introduction of laparoscopic wedge resection),


RESULTS
Fourteen patients (26%) underwent laparoscopic wedge resection with 1 conversion. The pathological exam showed that 41 patients (77%) had a GIST. Laparoscopic resection was significantly associated with a longer operative time, an earlier return of bowel function, earlier resumption of liquid and solid diet, decreased duration of parenteral or epidural analgesia use, and shorter postoperative hospitalization compared to open resection. There was no statistical difference in the rate of R1 resection and actuarial recurrence-free survival for the two approaches. Comparison between the two time periods demonstrated that the introduction of the laparoscopic approach in the latter period resulted in an earlier return of bowel function, earlier resumption of liquid and solid diet, and decreased duration of parenteral or epidural analgesia.


CONCLUSIONS
Laparoscopic wedge resection for gastric GIST can be safely adopted. It is associated with a more favorable perioperative outcome than the open approach. Its introduction as a surgical option has resulted in an improvement in perioperative outcomes without compromising oncologic safety at our institution.
Goh
Brian K P
BK
Department of Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore. bsgkp@hotmail.com
Chow
Pierce K H
PK
Chok
Aik-Yong
AY
Chan
Weng-Hoong
WH
Chung
Yaw-Fui A
YF
Ong
Hock-Soo
HS
Wong
Wai-Keong
WK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D016009:Chi-Square Distribution; D004032:Diet; D005240:Feasibility Studies; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013274:Stomach Neoplasms / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
D000700:Analgesics
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