Colette S Inaba, MD, Austin R Dosch, MD, Christina Y Koh, MD, Sarath Sujatha-Bhaskar, MD, Marija Pejcinovska, MS, Ninh T Nguyen, MD. University of California Irvine
BACKGROUND: Long-term studies on the role of laparoscopic resection of gastrointestinal stromal tumors (GISTs) have been limited. The objective of this study was to compare short- and long-term survival after laparoscopic versus open GIST resection.
METHOD: Data for gastric and small intestinal GIST operations were evaluated using the National Cancer Database (NCDB) from 2010-2014. After stratification by stage, patient demographics and outcomes were compared based on laparoscopic versus open surgical approaches. Primary outcome measures included adjusted 90-day mortality and Kaplan-Meier estimates of five-year survival. A Cox proportional hazards model was used to determine hazard ratios (HR) for survival. Secondary outcome measures included adjusted hospital length of stay (LOS) and 30-day readmission. Outcomes were adjusted for patient demographics, Charlson/Deyo comorbidity score, tumor size, and tumor location.
RESULTS: There were 5096 cases analyzed, including 2910 (56.4%) stage I, 1017 (19.7%) stage II, and 1232 (23.9%) stage III cases. The distribution of laparoscopic versus open cases was 1291 (44.4%) versus 1619 (50.6%) for stage I, 318 (37.5%) versus 636 (62.5%) for stage II, and 286 (23.2%) versus 946 (76.8%) for stage III, respectively. There was no significant difference in adjusted 90-day mortality between laparoscopic versus open resection. Kaplan-Meier estimates of five-year survival demonstrated improved overall survival curves for laparoscopic versus open resection for stage I (P=0.032) and stage II disease (P=0.012), but no difference for stage III disease (P=0.74). Factors associated with statistically significant higher mortality included older age (HR 1.06; P<0.001), male sex (HR 1.69; P<0.001) black race (HR 1.33; P=0.04), higher Charlson/Deyo comorbidity score (HR 1.47; P<0.001), and small intestine versus gastric location (HR 1.28; P=0.03). The hazards model suggested improved survival with laparoscopic compared to open resection (HR 0.80; P=0.06). Laparoscopy was associated with decreased LOS compared to open resection for all stages, but there was no statistical difference in 30-day readmission rates.
CONCLUSION: Laparoscopic and open approaches to GIST resection have comparable 90-day mortality with data suggesting improved five-year survival with laparoscopy. These findings support the use of laparoscopy as a viable and possibly more effective approach to resection of early-stage gastric or small intestinal GIST.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86390
Program Number: S015
Presentation Session: Outcomes/Quality Session
Presentation Type: Podium