Shorter operative time, a simpler operation, and faster postoperative recovery time are some of the advantages of hand-assisted laparoscopic surgery (HLS) compared with total laparoscopic surgery (TLS) for the surgical treatment of gastric gastrointestinal stromal tumors (GISTs), according to a retrospective analysis published in BMC Surgery.

TLS has replaced open surgery for the treatment of gastric GISTSs as a result of less blood loss and faster recovery time, however, HLS is minimally invasive and enables intraoperative decisions to be made regarding the scope and size of the tumor. This could protect normal stomach tissue and prevent intraoperative tumor rupture.

Researchers in China retrospectively analyzed clinical data from 53 patients diagnosed with gastric GISTs treated with TLS (n=36) or HLS (n=17) in a tertiary referral teaching hospital. The operative time of the HLS group was found to be notably shorter than that of the TLS group (70.6±19.1 min vs 134.4±53.7 min, respectively; P <.001).


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In addition, patients in the HLS group showed a shorter time to first flatus, less intraoperative blood loss, and a lesser time to fluid diet than those in the TLS group (P <.05). While no significant differences were found in the severity or incidence of complications between the 2 groups 30 days postsurgery, 1 patient in the HLS group and 3 patients in the TLS group reported a recurrence or metastasis.

Moreover, the maximum tumor margin was greatly shorter in the HLS group than in the TLS group (P =.004). Limitations of the study include small sample size and no long-term survival analysis.

‘It is an effective surgical method for [gastrointestinal] surgeons who have not fully mastered laparoscopic techniques,” the researchers said. Prospective randomized studies using multicenter data are needed to confirm the surgical benefits of HLS compared with TLS.

Reference

Zhao Y-J, Qiu Y-Q, Zhong L-Y, et al. Hand-assisted laparoscopic resection versus total laparoscopic gastric surgery for primary gastric gastrointestinal stromal tumors (GISTs): an analysis from a high-volume institution. BMC Surgery. Published online June 7, 2022. doi:10.1186/s12893-022-01668-y