title: Large gastrointestinal stromal tumours of the stomach: Is laparoscopy reasonable?
abstract: BACKGROUND
  Laparoscopic resection (LR) offers significant advantages compared to open resections for gastric gastrointestinal stromal tumours (GISTs). We aimed to evaluate whether LR outcomes jeopardised short and long-term outcomes of patients with large GISTs.
  
  
  METHODS
  Among 50 patients undergoing surgery for gastric GISTs, 12 underwent LR for large GISTs (>5 cm). Their characteristics, perioperative results and survival were retrospectively compared to those of 22 patients who underwent LR for 'small GIST'.
  
  
  RESULTS
  The two groups were similar regarding demographics, rate of wedge resection and mean blood loss. No patient required transfusion or conversion. Operative time was significantly increased in the 'large GIST' group (160 min vs 112 min, P = 0.001). Mean tumour size was significantly lower in the 'small GIST' group (8.4 cm vs 2.4 cm, P = 0.0001). Resection margins were negative. The mortality rate was nil and the overall morbidity rates was similar in both groups. Median length of hospital stay was significantly increased in the 'large GIST' group (7 days vs 5 days, P = 0.004). Median follow-up was 47 months and one patient in the 'small GIST' group developed recurrence and died during follow-up 11 years after surgery. No patient died during follow-up.
  
  
  CONCLUSIONS
  LR for large GISTs is safe and technically feasible and does not negatively influence the oncologic course. Prospective randomised trials should be performed before using this approach in routine surgical care.
authors.affiliation: Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France.
authors.forename: Beatrice Ulloa
authors.initials: BU
authors.lastname: Severino
authors.affiliation: Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Fuks
authors.affiliation: Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Lainas
authors.affiliation: Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Blain
authors.affiliation: Department of Pathology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Validire
authors.affiliation: Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Ferraz
authors.affiliation: Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Perniceni
authors.affiliation: Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France.
authors.forename: Brice
authors.initials: B
authors.lastname: Gayet
keywords: Gastrectomy; gastrointestinal stromal tumour (GIST); laparoscopy; resection