Surgical Management of Gastrointestinal Stromal Tumors (gist) of the Stomach. Comparison of Outcomes After Laparoscopic Versus Open Surgery. the Most Recent NSQIP Acs Database

Omar Bellorin, MD, Mingwei Ni, MD, Frank Zheng, Turner James, MD, Du Litong, MD. New York Hospital Queens. Flushing. New York

Introduction:
Laparoscopic gastrectomy for gastric GIST is emerging in the West as a technique that may offer benefits for patients, although large-scale studies are lacking. The goal of this project is to assess the outcomes with respect to 30-day morbidity and mortality rates, using multi-institutional, prospective, risk-adjusted data after laparoscopic versus open partial gastrectomies employed in the management of gastrointestinal stromal tumors of the stomach.

Methods and procedures:
Using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database (2006-2009), patients who underwent laparoscopic and open partial gastrectomy as a treatment option for gastric GIST were identified. Models assessed the association between surgical approach (Laparoscopic vs Open) and risk-adjusted overall morbidity and mortality. The relationships between, anesthesia time, operative duration, surgical site infection (SSI), and extended duration of hospital stay were also examined. Two-sample T-test was used as statistical method of analysis. Statistics for each analysis was based on the cases with no missing or out-of-range data for any variable in the analysis.

Results:
Of 486 patients, 146 (30%) underwent laparoscopic resection (LR) and 340 (70%) underwent open resection (OR). Patients who underwent LP were older (mean: 65.08 years) compared with those who underwent OR (mean: 62.59 years) although there was no difference statistically (P:0.062). Patients treated with LR experienced shorter anesthesia time (mean: 183 vs 212 minutes; P<0.005; 95% confidence of interval [CI], 48.14-9.56) as well as an operative time (mean: 119 vs 149 minutes, P <0.005; 95% CI, 47.05-12.70) compared to those who underwent OR. All patients treated with LR were significantly less likely to develop SSI compared to those who underwent OR (0.68% vs 6.7%; P<0.005). Patients treated with LR were less likely to experience an overall morbidity (mean: 3.9% vs 11.7%; P<0.005; 95% CI, 0.096-0.059) or mortality (mean: 0.23% vs 0.72% ; P<0.005; 95% CI, 0.066-0.031) and less length of total hospital stay (mean: 3.17 vs 7.50 days; P:<0.005; 95% CI, 5.29-3.36) compared with those who underwent OR.

Conclusion:
Within ACS NSQIP hospitals, laparoscopic resection of gastric GIST is associated with lower overall morbidity and mortality, less operative time, less risk of SSI and less length of total hospital stay compared to those who underwent open resection.
 

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