Safety and Efficacy of Laparoscopic Wedge Gastrectomy for Large Gastrointestinal Stromal Tumors

Publication date: Available online 18 January 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): M. Milone, U. Elmore, M. Musella, P. Parise, M.C. Zotti, U. Bracale, K. Di Lauro, M. Manigrasso, F. Milone, R. Rosati
BackgroundAlthough the feasibility of minimally invasive resection of small gastric GISTs is well established, less is known about safety and efficacy of laparoscopic surgery for large tumors.MethodsA retrospective analysis was performed, using a prospectively maintained comprehensive database. Patients were divided into two groups according to tumor size: Case group with tumors > 5cm and control group with tumors < 5 cm. Hospital charts were reviewed, and various outcome measures recorded, including operative time, estimated operative blood loss, post-operative leak, stasis, infection and recurrence.ResultsNo tumors were ruptured during surgical manipulation and no major morbidity or mortality occurred in either group. Operative time (75,8 ± 33,1 min in large cases vs 75,8 ± 33,1 min in small cases) was similar in both groups (p = 0,61). The incidence of post-operative complications did not differ between the two groups. In details there were 21 out of 25 (84%) uncomplicated cases among small GISTs versus 17 out of 24 (70,8%) uncomplicated cases among large GISTs (p = 0,32).ConclusionThis matched-pair case control study demonstrates that laparoscopic wedge resection for large gastric GISTs is safe and effective, as demonstrated for small tumors.

Teaser

Core tip: The primary goal of treatment for localized gastric GISTs is surgical resection with negative margins; it is the only chance to obtain a complete cure. Simple wedge resection, when feasible, has become the recommended surgical approach. Although the feasibility of minimally invasive resection of small gastric GISTs is well established, less is known about safety and efficacy of laparoscopic surgery for large tumors. Our comparative analysis provided the rationale to include large gastric GISTs for laparoscopic gastric resection.


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