Surgical resection is a treatment for individuals with gastrointestinal stromal tumors (GISTs), however, questions have arisen about the highest efficacy among 2 surgical approaches: laparoscopic vs conventional open surgery.
While both surgical types resulted in statistically similar rates of long-term patient outcomes such as overall and progression-free survival, laparoscopic surgeries demonstrated more statistically favorable short-term outcomes, according to a new study published in the Journal of Minimal Access Surgery.
Such beneficial short-term outcomes included quicker recovery of gastrointestinal function measured by time to oral intake (P <.05) and time to first flatus (P =.001), shorter hospitalization periods (12 days vs 14 days, P =.001), less blood loss (50 mL vs 100 mL, P <.05), and faster removal of the drainage tube (6 days vs 7 days, P <.05).
In the laparoscopic group, patients walked independently sooner, were fed earlier, and needed little gastrointestinal intervention following surgery, which improved the speed of gastrointestinal function recovery.
One drawback of laparoscopic surgeries was the higher cost compared with open surgeries due to specific devices and techniques required to perform the surgery.
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The investigators enrolled and retrospectively analyzed data from 148 patients with gastric GISTs who had surgical treatment. They selected 104 patients following 1:1 propensity score matching to minimize confounding variables and divided these patients into 2 groups: 52 patients in the laparoscopic surgical group and 52 patients in the open surgical group.
Surgeons with 15 to 20 years of experience performed the operations keeping 3 clinical practice guidelines in mind: avoidance of direct contact with the fragile tumor surface to avoid tumor rupture which might lead to intraperitoneal seeding, resection of the tumor using a negative resection margin, and avoidance of lymph node resection unless it was necessary.
Collection of data included patient age, sex, initial clinical findings, preoperative patient health status and comorbidities, family cancer history, tumor size and location, mitotic count, tumor classification according to the National Institutes of Health, positive resection margin rate, histopathological classification, Ki-67 index, immunohistochemical analysis results (CD117, CD34, S100, and DOG1), and use of imatinib therapy following surgery.
The primary endpoints of the study were disease-free (progression-free) survival rates and overall survival rates. Intraoperative complications included hemorrhaging (blood loss > 800 mL), incomplete hemostasis, and organ injury. Postoperative complications included anastomotic leakage, delayed gastric emptying, infection, and bleeding.
Zhao Hui X, Hui Q, Yan Ying R, et al. A propensity score-matched analysis of laparoscopic versus open surgical radical resection for gastric gastrointestinal stromal tumor. J Minim Access Surg. Published online November 8, 2021. doi:10.4103/jmas.jmas_199_21