title: Laparoscopic Versus Open Surgery for Gastric Gastrointestinal Stromal Tumors: What Is the Impact on Postoperative Outcome and Oncologic Results?
abstract: OBJECTIVE
  The aim of the study was to compare the postoperative and oncologic outcomes of laparoscopic versus open surgery for gastric gastrointestinal stromal tumors (gGISTs).
  
  
  BACKGROUND
  The feasibility of the laparoscopic approach for gGIST resection has been demonstrated; however, its impact on outcomes, particularly its oncologic safety for tumors greater than 5 cm, remains unknown.
  
  
  METHODS
  Among 1413 patients treated for a GIST in 61 European centers between 2001 and 2013, patients who underwent primary resection for a gGIST smaller than 20 cm (N = 666), by either laparoscopy (group L, n = 282) or open surgery (group O, n = 384), were compared. Multivariable analyses and propensity score matching were used to compensate for differences in baseline characteristics.
  
  
  RESULTS
  In-hospital mortality and morbidity rates in groups L and O were 0.4% versus 2.1% (P = 0.086) and 11.3% vs 19.5% (P = 0.004), respectively. Laparoscopic resection was independently protective against in-hospital morbidity (odds ratio 0.54, P = 0.014). The rate of R0 resection was 95.7% in group L and 92.7% in group O (P = 0.103). After 1:1 propensity score matching (n = 224), the groups were comparable according to age, sex, tumor location and size, mitotic index, American Society of Anesthesiology score, and the extent of surgical resection. After adjustment for BMI, overall morbidity (10.3% vs 19.6%; P = 0.005), surgical morbidity (4.9% vs 9.8%; P = 0.048), and medical morbidity (6.2% vs 13.4%; P = 0.01) were significantly lower in group L. Five-year recurrence-free survival was significantly better in group L (91.7% vs 85.2%; P = 0.011). In tumors greater than 5 cm, in-hospital morbidity and 5-year recurrence-free survival were similar between the groups (P = 0.255 and P = 0.423, respectively).
  
  
  CONCLUSIONS
  Laparoscopic resection for gGISTs is associated with favorable short-term outcomes without compromising oncologic results.
authors.affiliation: *Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France †Univ Lille Nord de France, Lille, France ‡Inserm, UMR-S-1172, Jean Pierre Aubert Research Center (JPARC), Team "Mucins, epithelial differentiation and carcinogenesis", Lille, France §SIRIC OncoLille, Lille, France ¶Department of General and Digestive Surgery, Saint-Antoine Hospital, University Pierre & Marie Curie, Paris, France ||Department of Digestive Surgery of Haut-Levêque University Hospital, Bordeaux, France **Department of Biostatistics, University Hospital, Lille, France ††Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris, France ‡‡Department of Digestive Surgery, Croix-Rousse University Hospital, Lyon, France §§Department of Digestive Surgery, Amiens Picardie University Hospital, Amiens, France ¶¶Department of Surgery, Institut Gustave Roussy, Villejuif, France ||||General Surgery, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy ***Department of Digestive Surgery, Dupuytren University Hospital, Limoges, France †††Department of Digestive Surgery, Nantes University Hospital, Nantes, France ‡‡‡Department of Digestive Surgery, Grenoble University Hospital, Grenoble, France §§§Department of Digestive Surgery, Lyon Sud University Hospital, Lyon, France ¶¶¶Department of Surgery of Institut Curie, Paris, France ||||||Department of Digestive Surgery, Saint André University Hospital, Bordeaux, France ****Department of Digestive Surgery, Beaujon University Hospital, Clichy, France ††††Department of Digestive Surgery, Saint Louis University Hospital, Paris, France ‡‡‡‡Department of Digestive Surgery, Pitié-Salpêtrière University Hospital, Paris, France §§§§Department of Digestive Surgery, New Civil University Hospital, Strasbourg, France ¶¶¶¶Department of Digestive Surgery, Cavale Blanche University Hospital, Brest, France ||||||||Department of D
authors.forename: Guillaume
authors.initials: G
authors.lastname: Piessen
authors.forename: Jérémie H
authors.initials: JH
authors.lastname: Lefèvre
authors.forename: Magalie
authors.initials: M
authors.lastname: Cabau
authors.forename: Alain
authors.initials: A
authors.lastname: Duhamel
authors.forename: Héléne
authors.initials: H
authors.lastname: Behal
authors.forename: Thierry
authors.initials: T
authors.lastname: Perniceni
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Mabrut
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Regimbeau
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bonvalot
authors.forename: Guido A M
authors.initials: GA
authors.lastname: Tiberio
authors.forename: Muriel
authors.initials: M
authors.lastname: Mathonnet
authors.forename: Nicolas
authors.initials: N
authors.lastname: Regenet
authors.forename: Antoine
authors.initials: A
authors.lastname: Guillaud
authors.forename: Olivier
authors.initials: O
authors.lastname: Glehen
authors.forename: Pascale
authors.initials: P
authors.lastname: Mariani
authors.forename: Quentin
authors.initials: Q
authors.lastname: Denost
authors.forename: Léon
authors.initials: L
authors.lastname: Maggiori
authors.forename: Léonor
authors.initials: L
authors.lastname: Benhaim
authors.forename: Gilles
authors.initials: G
authors.lastname: Manceau
authors.forename: Didier
authors.initials: D
authors.lastname: Mutter
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Bail
authors.forename: Bernard
authors.initials: B
authors.lastname: Meunier
authors.forename: Jack
authors.initials: J
authors.lastname: Porcheron
authors.forename: Christophe
authors.initials: C
authors.lastname: Mariette
authors.forename: Cécile
authors.initials: C
authors.lastname: Brigand
mesh_terms: D005060:Europe / Q000453:epidemiology; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D046152:Gastrointestinal Stromal Tumors / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D011184:Postoperative Period; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome