The 10-year experience of 3 Italian centers points to the safety of minimally invasive approaches to treat gastrointestinal stromal tumors (GISTs) localized in the stomach.
The study included 81 patients treated with minimally invasive surgery, either laparoscopy (n=36) or robotic surgery (n=45). The average tumor size was 4.4 cm. To better assess long-term safety and effectiveness of the approaches, Ceccarelli et al followed up with patients (n=72) for more than 3 years.
The American Society of Anesthesiologists (ASA) score was 4 (11.1%) for laparoscopy and 6 (13.3%) for robotic surgery. Most (93.8%) of the procedures were wedge resections. The main operative times were 97 minutes for laparoscopy and 151 minutes for robotic surgery. Five cases (6.2%) required conversion.
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The robotic approach was particularly useful to treat gastric GISTs larger than 5 cm, even when their localization was unfavorable (iuxtacardial, lesser curvature, and antro-pyloric regions). Ceccarelli et al explained, “We treated with a robotic approach more challenging patients affected by moderate or high-risk tumors in unfavorable positions, often performing simultaneous procedures or major gastric resection, without negative impact on outcomes.”
Robotic approaches allow for “tailored resections,” thereby avoiding the unnecessary removal of the gastric wall. Also, in difficult conditions, it is possible to perform an “organ-sparing” approach by respecting the margins and reducing the risk of rupture. According to the study authors, this prevents the postoperative stomach deformations or strictures observed when using conventional laparoscopic staplers.
However, robotic technologies are pricey. Therefore, they should be reserved at tertiary referral centers for challenging gastric GIST cases, such as in obese patients and situations that require complex surgical procedures, the researchers wrote.
Ceccarelli G, Costa G, De Rosa M, et al. Minimally invasive approach to gastric GISTs: analysis of a multicenter robotic and laparoscopic experience with literature review. Cancers (Basel). 2021;13(17):4351. doi:10.3390/cancers13174351