Yuchen Zhou, MS, Ke Chen, MS, Yiping Mou, MD, FACS. Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University.
INTRODUCTION: To evaluate the safety and efficacy of laparoscopic resection for gastric stromal tumors with systematic review and meta-analysis.
METHODS AND PROCEDURES: The literature database before September, 2013 was extensively searched to retrieve the comparative studies of laparoscopic (LR) and open resection(OR) for gastric stromal tumors with a relevance of study goal. The inclusion and exclusion criteria were formulated. After a quality evaluation, the data were extracted.The Cochrane collaboration RevMan5.1 version software was used for meta-analysis.
RESULTS: There are thirteen studies meeting the inclusion criteria for meta-analysis. The total sample size of these studies was 792 cases. The operation time was similar between the two groups [weighted mean difference (WMD)= -7.57min, 95% confidence interval(CI): -32.86 ~ 17.73, P=0.56)]. Compared to OR, however, LR experience less blood loss (WMD = -48.88 ml, 95% CI: -72.90 ~ -24.85, P<0.001), earlier time to ?atus (WMD = -1.60 d, 95% CI: -2.03 ~ -1.17, P<0.001) and oral diet (WMD = -1.68 d, 95% CI: -2.33 ~ -1.03, P<0.001), shorter hospital stay (WMD = -3.55 d, 95% CI: -4.56 ~ -2.53, P<0.001) and decrease in overall complications [relative risk(RR)= 0.57, 95% CI: 0.33 ~ 0.97, P=0.04)]. In addition, the long-term follow-up result shows that there is no significant difference in the two groups of patients.
CONCLUSIONS: laparoscopic resection for gastrointestinal stromal tumors of the stomach is a safe and feasible procedure with less blood loss, less overall complications and quick recovery. The long-term survival situation of gastric stromal tumor patients mainly depends on the tumor itself risk, and laparoscopic surgery will not increase the risk of tumor relapse and metastasis.