Long-term outcomes of treatment of gastric gastrointestinal stromal tumor by laparoscopic surgery: review of the literature and our experience.
OBJECTIVE
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 October 2003 and June 2012, 24 consecutive patients undergoing laparoscopic resection of gastric GISTs were enrolled in a prospective study. A comparison with authors' experience with laparoscopic wedge-segmental resection of GISTs was also carried out.


RESULTS
Twenty-four patients, mean age 64.0 +/- 11.2 years, were submitted to laparoscopic wedge-segmental gastric resections. Mean tumor size was 3.1 +/- 1.2 cm, mean operative time was 118.0 +/- 57.3 min, mean blood loss was 21.6 +/- 47.7 mL, and mean hospital stay was 7.1 +/- 1.9 days. There were no major operative complications or mortalities. All lesions had negative resection margins. Postoperative complications were detected in 2 patients. The rate of complication of grade 2 was 8.3%. At a mean follow-up of 23.9 months, all patients were disease-free. Morbidity, mortality, length of stay, and oncologic outcomes were comparable to experience with an extensive literature review. The stomach was divided into 3 areas (U, M, L area). When operation time and blood loss were examined, a significant difference was not indicated. However, both operation time and blood loss of M area tended to be low compared with U area. According to the mitotic index, 21 (87.5%) tumors were evaluated as low risk, 2 (7.3%) tumors as medium risk, and 1 (4.2%) tumor as high risk.


CONCLUSIONS
Laparoscopic resection is safe and effective in treating gastric GISTs. Therefore, a minimally invasive approach should be the preferred surgical treatment in patients with small- and medium-sized gastric GISTs.
Nobuhisa
N
Matsuhashi
Shinji
S
Osada
Kazuya
K
Yamaguchi
Naoki
N
Okumura
Yoshihiro
Y
Tanaka
Hisashi
H
Imai
Yoshiyuki
Y
Sasaki
Kenichi
K
Nonaka
Takao
T
Takahashi
Manabu
M
Futamura
Kazuhiro
K
Yoshida
D000328:Adult; D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D046152:Gastrointestinal Stromal Tumors / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden