Researchers have found that laparoscopic resection of gastrointestinal stromal tumors (GISTs) is a feasible method of treatment in patients with large tumors that have been downsized by neoadjuvant therapy. These patients have the same favorable post-surgical outcomes as patients with smaller tumors, a study published in the Journal of Gastrointestinal Cancer has shown.
This represents an evolution in thinking from the European Society for Medical Oncology (ESMO) recommendation that laparoscopic resection is performed only for small-size GISTs to reduce the risk of intraoperative spillage (a significant risk factor for tumor recurrence).
The retrospective study was conducted in the surgical oncological unit at the Oncology Center at Mansoura University, Egypt. Thirty patients who were diagnosed with gastric GISTs of all sizes underwent laparoscopic partial gastrectomy between December 2013 and January 2021. The most common complaints were dyspepsia and bleeding. The mean age was 53.67 years and the mean BMI was 32.50 kg/m2. Most patients were male (56.7%) and had an American Society of Anesthesiology (ASA) score of I (93.3%).
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GISTs most commonly occurred at the greater curvature of the stomach (46.7%). The mean tumor size was 7.2 cm, the largest being 17 cm (which was downsized to 6 cm after 12-month neoadjuvant therapy before resection was performed). Ten patients received neoadjuvant therapy before surgery. Intraoperatively, the mean operative time was 152.67 minutes and the mean estimated blood loss was 139.33 ml.
Postoperatively, the mean follow-up time was 32.4 months. Postoperative (adjuvant) therapy with imatinib was administered in 23 (76.7%) of the patients, with the mean duration of treatment being 20.78 months. Of all the patients treated, only one (3.3%) developed local recurrence with hepatic and peritoneal disease 48 months after the primary diagnosis.
The fact that 96.7% of patients did not experience disease recurrence demonstrates that laparoscopic partial gastrectomy is indeed feasible even for gastric GISTs traditionally viewed as too large to be resected.
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Laparoscopic surgery has become the surgical method of choice in abdominal surgery compared to traditional open surgery because it reduces intraoperative blood loss and postoperative pain, the study authors wrote. This study demonstrates that large GISTs may not be a barrier for laparoscopic partial gastrectomy should they be adequately downsized through neoadjuvant therapy prior to surgery.
Abouzid A, Setit A, Fathi A, Shetiwy M. Laparoscopic partial gastrectomy for large gastric GISTs. J Gastrointest Cancer. Published online July 10, 2021. doi:10.1007/s12029-021-00658-2.