Minimally invasive surgery for gastric gastrointestinal stromal tumors (GISTs) measuring 5-10 cm or more may offer improved postoperative morbidity as well as oncologic safety, according to a new study that was published in Surgical Endoscopy.

Moreover, the approach results in similar long-term survival compared to open surgery and national guidelines may need to incorporate this new information, the authors said.

While minimally invasive surgery is often used to remove small gastric GISTs, it is currently not endorsed by national guidelines as the standard of care to remove tumors measuring  5 cm or more because of safety and inferior oncologic outcome concerns.


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Here, a team of researchers led by Claudius Conrad, MD, PhD, from the Department of Surgery at Tufts University School of Medicine in Boston, Massachusetts investigated the perioperative and long-term outcomes of minimally invasive surgery for T3 gastric GISTs measuring 5-10 cm.

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The researchers analyzed 3765 patients with a mean tumor size of 6.73 cm. Of those, 26.3% had minimally invasive surgery while 73.8% had open surgery.

They found that the median hospital stay was shorter for patients who had minimally invasive surgery and that there was no significant difference in the incidence of R1 margins unplanned readmission, 30-day mortality, and 90-day mortality between the 2 approaches. Statistical analyses also showed no difference in terms of survival between patients who underwent minimally invasive surgery and open surgery.

“Our data suggest that [minimally invasive surgery] vs. open surgery provides statistically non-inferiority long-term survival,” the researchers wrote. “This information may inform an ongoing discussion regarding national guidelines in the management of this increasingly common cancer type.”

Radical and complete surgical resection is a treatment for GIST, and medical care with tyrosine kinase inhibitors is also available. 

Reference

Crocker AB, Vega EA, Kutlu OC, et al. Is minimally invasive surgery for large gastric GIST actually safe? A comparative analysis of short- and long-term outcomes. Surg Endosc. Published online March 21, 2022. doi:10.1007/s00464-022-09066-4