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Minerva Surgery 2021 May 28

DOI: 10.23736/S2724-5691.21.08574-9


language: English

Laparoscopic vs Open Resection of Gastrointestinal Stromal Tumors (GISTs) from Gastric Origin: different approaches for different diseases

Fausto ROSA 1, 2 , Riccardo RICCI 2, 3, Federica GALIANDRO 1, Caterina CINA 1, Roberta MENGHI 1, Giuseppe QUERO 1, Claudio FIORILLO 1, Fabio LONGO 1, Antonio P. TORTORELLI 1, Sergio ALFIERI 1, 2

1 Department of Digestive Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; 2 Università Cattolica del Sacro Cuore, Rome, Italy; 3 Department of Pathology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy


BACKGROUND: Although minimally invasive techniques are currently recognized as effective and validated treatment for small gastric gastrointestinal stromal tumors (GISTs), the role of laparoscopy is not yet established. The aim of this study was to evaluate the outcomes of laparoscopic treatment of gastric GISTs compared to the results obtained in a group of patients treated with conventional surgery.
METHODS: A retrospective analysis was performed, using a prospectively maintained comprehensive database of 100 patients treated for gastric GIST in the period from 2000 to 2015. Thirty-six patients were treated laparoscopically and 64 patients underwent conventional surgery. The analyzed medical data included clinical and pathological features of removed tumors, perioperative parameters as well as short and long-term results of surgical treatment.
RESULTS: Histopathological examination confirmed radical resection for all patients. No deaths were reported in the 90-day post-operative period. Patients in laparoscopic group had significantly shorter length of hospital stay (5.5 vs. 7 days, p<0.0001), fewer extended and combined surgical procedures (11.2% vs 34.4% and 2.8% vs 39%; p=0.02 and p<0.001, respectively), and a smaller tumor size compared to laparotomic group (3 vs 6 cm, p<0.0001). The median post-operative follow-up for the entire study population was 42 months. During this period, 11 patients died and 4 of them developed a tumor recurrence. None of them was in the laparoscopic group.
CONCLUSIONS: Laparoscopy in the treatment of gastric GISTs has unquestionable advantages, but its choice is strictly related to tumor features.

KEY WORDS: GIST; Laparoscopy; Outcomes; Survival

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