A study recently published in Scientific Reports demonstrated that laparoscopic resection of gastric gastrointestinal stromal tumors (GISTs) resulted in fewer wounds, a lower overall complication rate, and shorter hospital stays than open surgery.

This retrospective study conducted by Park et al included 636 patients with gastric GISTs who were equally divided using 1:1 propensity score matching (PSM) into 2 groups: open and laparoscopic. Of all patients scheduled for laparoscopic surgery, 3.8% ended in conversion to open surgery, primarily due to a tumor size larger than 5 cm.

The rates of overall complications were 3.5% and 7.9% in the laparoscopic and open groups, respectively. Wound complications were present in 0.6% of the laparoscopic patients vs 3.1% of the open surgery patients. Disorders of intestinal motility were only reported in the open group. On average, hospitalization stay was 2.1 days longer in open surgery patients than in laparoscopic patients.


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Although the laparoscopic approach remains superior, the operation time was longer in this group than in the open group after PSM, with an average of 114.0 minutes vs 100.8 minutes, respectively. Moreover, no differences were observed between the 2 groups regarding recurrence-free survival; rather, the authors noted that tumor size >5 cm, higher mitotic count, tumor rupture during surgery, and R1 resection correlated with higher rates of recurrence. Interestingly, the laparoscopic cases did not report tumor rupture.

In a disease where complete surgical resection remains the standard treatment, determining the best approach proposes high clinical value. This study hypothesized that the success of the laparoscopic approach was due to a higher magnified view, which permits more precise dissection, less manipulation of other organs including the bowel, and smaller surgical wounds that allow earlier ambulation and therefore aid in an earlier return of normal peristalsis.

“Even in the early era of laparoscopic surgery with unrefined experiences, laparoscopic resection could provide a lower rate of complications and shorter hospitalization for patients with gastric GIST than open surgery, without compromising oncological safety,” the authors concluded.

Reference

Park SH, Lee HL, Kim MC, et al. Early experience of laparoscopic resection and comparison with open surgery for gastric gastrointestinal stromal tumor: a multicenter retrospective study. Sci Rep. 2022;12(1):2290. doi:10.1038/s41598-022-05044-x