Laparoscopic Resection of Gastrointestinal Stromal Tumors (gist) – Report of 62 Cases and Comparison to Open Resection

Michael J Pucci, MD, Francesco Palazzo, MD, Bernadette C Profeta, MD, Pei-wen Lim, BS, Karen A Chojnacki, MD, Ernest L Rosato, MD, Adam C Berger, MD. Thomas Jefferson University Hospital, Department of Surgery, Philadelphia, PA, USA

Background: As advanced techniques in laparoscopy improve, laparoscopic resection of GISTs is becoming more common. We reviewed our large, single-institution experience with laparoscopic resection of GISTs to determine safety and efficacy.

Methods: Between January 2003 and July 2011, 62 patients underwent laparoscopic resection of GISTs (57 gastric, 5 other). Using an IRB-approved prospectively maintained database, data on sex, age, tumor size, location, symptoms, margin status, operative time, blood loss (EBL), length of stay, and complications were collected. This data was compared to a contemporary series of 54 patients, who underwent open resection (47 gastric, 7 other).

Results: The average age of patients in the laparoscopic group was 61 years (range= 22 to 89) compared to 64 (range=27 to 87) in the open group. The mean tumor size was significantly lower in the laparoscopic group (3.8 vs. 9.0cm, p<0.001). The average blood loss (39 vs. 462ml, p<0.0001) and median length of stay (4.2 vs. 11.1 days, p<0.0001) were significantly decreased in the laparoscopic cohort. There was a 6% major complications in the laparoscopic group compared to 35% major complication rate in the open group (p<0.0001). In terms of oncologic efficacy, 95% of the cases in the laparoscopic series achieved a R0 resection compared to 93% in the open group.

Conclusions: Laparoscopic resection is safe and efficacious in treating gastric GISTs. Small and medium-sized GISTs lend themselves to laparoscopic resections. Given the advantages of laparoscopic surgery, a minimally invasive approach should be the preferred treatment in patients with small and medium-sized gastric GISTs.

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