Laparoscopic Versus Open Resection of Gastrointestinal Stromal Tumors (gists)

INTRODUCTION: GISTs are the most common mesenchymal tumors of the gastrointestinal tract. Although they can occur anywhere along the gastrointestinal tract, they are most commonly identified in the stomach. Surgery is the optimal therapy in the majority of patients with non-metastatic GISTs. There is still some controversy as to the effectiveness of laparoscopic resection of these tumors in obtaining negative margins to minimize recurrence risk. GISTs have traditionally been managed by open surgical resection. Increasingly these lesions are managed laparoscopically. The hypothesis of this study was that laparoscopic resection of gastric GISTs would offer similar perioperative outcomes compared to the traditional open approach, while affording patients the benefits of a laparoscopic approach.

METHODS: A retrospective review of a prospectively collected database was conducted on all GISTs treated at a tertiary care urban teaching hospital between January 1999 and August 2008. The complete medical record of each patient was examined for demographic and clinicopathological features. The pathology reports were reviewed for tumor size, margin status, c-KIT/CD34 staining, mitotic activity and necrosis. The medical record was also reviewed for type of resection (laparoscopic versus open), tumor location, operative time, estimated blood loss, perioperative complications and length of stay. Data were statistically analyzed via Chi-square analysis and students t-test where appropriate.

RESULTS: Sixty-six patients were identified with a pathological diagnosis of GIST. We excluded GISTs found incidentally during other operations and GISTs not located in the stomach. With the above exclusion criteria, 46 gastric GISTs were identified. There were 17 treated laparoscopicaly and 29 treated via the traditional open approach. The median age of patients in these groups were comparable at 62 and 60 respectively. Body mass index of these patients were also similar at 28.2 kg/m2 for the laparoscopic and 29.9 kg/m2 for the open group. The average size of tumors were slightly smaller in the laparoscopic group at 4.27 cm versus the open group at 6.39 cm, however, this was not statistically significant. The estimated blood loss for the laparoscopic group was lower at 94 mL versus 169 mL (P=0.059). Operative time for the two surgical approaches were not significantly different at 135 minutes for laparoscopic and 157.4 minutes for open. Laparoscopic resection yielded a significantly shorter length of stay compared to open at 2.68 versus 6.25 days (P

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Program Number: P012

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