Skip to main content
Top
Published in: Surgical Endoscopy 9/2022

21-03-2022 | Gastrectomy | 2021 SAGES Oral

Is minimally invasive surgery for large gastric GIST actually safe? A comparative analysis of short- and long-term outcomes

Authors: Andrew B. Crocker, Eduardo A. Vega, Onur C. Kutlu, Omid Salehi, Sebastian Mellado, Mu Li, Olga Kozyreva, Claudius Conrad

Published in: Surgical Endoscopy | Issue 9/2022

Login to get access

Abstract

Introduction

While minimally invasive surgery (MIS) is frequently utilized to remove small gastric gastrointestinal stromal tumors (GIST), MIS surgery for tumors ≥ 5 cm is currently not endorsed by national guidelines as standard of care due to concerns of safety and inferior oncologic outcomes. Hence this study investigates the perioperative and long-term outcomes of MIS for T3 gastric GIST measuring 5–10 cm.

Methods

The National Cancer Database (NCDB) 2017 was queried for gastric GIST measuring 5–10 cm or T3 category. Inclusion criteria were known: stage, size, comorbidities, grade, lymphovascular invasion, type of surgery, approach, conversion info, margin status, mitotic rate, neoadjuvant and adjuvant treatment, hospital stay, readmission, 30- and 90-day mortality, complete follow-up, type of institution, and hospital gastric surgery case volume. Binary logistic regression, linear regression models, and Kaplan–Meier survival analysis were used.

Results

In 3765 patients, mean tumor size was 67.3 mm; 26.3% MIS; and 73.8% open. Median hospital stay was shorter for MIS (4.77 vs 7.04 days, p < 0.001). There was no significant difference in incidence of R1 margins [2.9% MIS vs. 3.1% open (p = 0.143)], unplanned readmission [2.9% MIS and 4.1% open (OR 0.474 p = 0.025)], 30-day mortality [0.5% MIS vs 1.2% open (OR 0.325, p = 0.031)], and 90-day mortality [0.9% MIS vs 2.1% open (OR 0.478 p = 0.036)]. Cox regression models for OS showed no difference in survival (p = 0.137, HR 0.808).

Conclusion

This analysis provides substantial evidence that MIS for gastric GIST ≥ 5–10 cm may not only offer improved postoperative morbidity but also oncologic safety. Moreover, as both approaches lead to similar long-term survival, national guidelines may need to incorporate this new information.

Graphical abstract

Appendix
Available only for authorised users
Literature
1.
go back to reference Demetri GD, Benjamin RS, Blanke CD, Blay J-Y, Casali P, Choi H, Corless CL, Debiec-Rychter M, DeMatteo RP, Ettinger DS (2007) NCCN Task Force report: management of patients with gastrointestinal stromal tumor (GIST)—update of the NCCN clinical practice guidelines. Journal of the National Comprehensive Cancer Network 5:S-1-S-29CrossRef Demetri GD, Benjamin RS, Blanke CD, Blay J-Y, Casali P, Choi H, Corless CL, Debiec-Rychter M, DeMatteo RP, Ettinger DS (2007) NCCN Task Force report: management of patients with gastrointestinal stromal tumor (GIST)—update of the NCCN clinical practice guidelines. Journal of the National Comprehensive Cancer Network 5:S-1-S-29CrossRef
2.
go back to reference Group ESESNW (2014) Gastrointestinal stromal tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 25 Suppl 3:iii21–26 Group ESESNW (2014) Gastrointestinal stromal tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 25 Suppl 3:iii21–26
3.
go back to reference Demetri GD, Benjamin RS, Blanke CD, Blay JY, Casali P, Choi H, Corless CL, Debiec-Rychter M, DeMatteo RP, Ettinger DS, Fisher GA, Fletcher CD, Gronchi A, Hohenberger P, Hughes M, Joensuu H, Judson I, Le Cesne A, Maki RG, Morse M, Pappo AS, Pisters PW, Raut CP, Reichardt P, Tyler DS, Van den Abbeele AD, von Mehren M, Wayne JD, Zalcberg J, Force NT (2007) NCCN Task Force report: management of patients with gastrointestinal stromal tumor (GIST)--update of the NCCN clinical practice guidelines. J Natl Compr Canc Netw 5 Suppl 2:S1–29; quiz S30 Demetri GD, Benjamin RS, Blanke CD, Blay JY, Casali P, Choi H, Corless CL, Debiec-Rychter M, DeMatteo RP, Ettinger DS, Fisher GA, Fletcher CD, Gronchi A, Hohenberger P, Hughes M, Joensuu H, Judson I, Le Cesne A, Maki RG, Morse M, Pappo AS, Pisters PW, Raut CP, Reichardt P, Tyler DS, Van den Abbeele AD, von Mehren M, Wayne JD, Zalcberg J, Force NT (2007) NCCN Task Force report: management of patients with gastrointestinal stromal tumor (GIST)--update of the NCCN clinical practice guidelines. J Natl Compr Canc Netw 5 Suppl 2:S1–29; quiz S30
4.
go back to reference Sasaki A, Koeda K, Obuchi T, Nakajima J, Nishizuka S, Terashima M, Wakabayashi G (2010) Tailored laparoscopic resection for suspected gastric gastrointestinal stromal tumors. Surgery 147:516–520CrossRef Sasaki A, Koeda K, Obuchi T, Nakajima J, Nishizuka S, Terashima M, Wakabayashi G (2010) Tailored laparoscopic resection for suspected gastric gastrointestinal stromal tumors. Surgery 147:516–520CrossRef
5.
go back to reference Ye X, Kang WM, Yu JC, Ma ZQ, Xue ZG (2017) Comparison of short- and long-term outcomes of laparoscopic vs open resection for gastric gastrointestinal stromal tumors. World J Gastroenterol 23:4595–4603CrossRef Ye X, Kang WM, Yu JC, Ma ZQ, Xue ZG (2017) Comparison of short- and long-term outcomes of laparoscopic vs open resection for gastric gastrointestinal stromal tumors. World J Gastroenterol 23:4595–4603CrossRef
6.
go back to reference Xu C, Chen T, Hu Y, Balde AI, Liu H, Yu J, Zhen L, Li G (2017) Retrospective study of laparoscopic versus open gastric resection for gastric gastrointestinal stromal tumors based on the propensity score matching method. Surg Endosc 31:374–381CrossRef Xu C, Chen T, Hu Y, Balde AI, Liu H, Yu J, Zhen L, Li G (2017) Retrospective study of laparoscopic versus open gastric resection for gastric gastrointestinal stromal tumors based on the propensity score matching method. Surg Endosc 31:374–381CrossRef
7.
go back to reference Casali PG, Abecassis N, Aro HT, Bauer S, Biagini R, Bielack S, Bonvalot S, Boukovinas I, Bovee J, Brodowicz T, Broto JM, Buonadonna A, De Alava E, Dei Tos AP, Del Muro XG, Dileo P, Eriksson M, Fedenko A, Ferraresi V, Ferrari A, Ferrari S, Frezza AM, Gasperoni S, Gelderblom H, Gil T, Grignani G, Gronchi A, Haas RL, Hassan B, Hohenberger P, Issels R, Joensuu H, Jones RL, Judson I, Jutte P, Kaal S, Kasper B, Kopeckova K, Krakorova DA, Le Cesne A, Lugowska I, Merimsky O, Montemurro M, Pantaleo MA, Piana R, Picci P, Piperno-Neumann S, Pousa AL, Reichardt P, Robinson MH, Rutkowski P, Safwat AA, Schoffski P, Sleijfer S, Stacchiotti S, Sundby Hall K, Unk M, Van Coevorden F, van der Graaf WTA, Whelan J, Wardelmann E, Zaikova O, Blay JY, Committee EG, Euracan (2018) Gastrointestinal stromal tumours: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 29:iv68-iv78 Casali PG, Abecassis N, Aro HT, Bauer S, Biagini R, Bielack S, Bonvalot S, Boukovinas I, Bovee J, Brodowicz T, Broto JM, Buonadonna A, De Alava E, Dei Tos AP, Del Muro XG, Dileo P, Eriksson M, Fedenko A, Ferraresi V, Ferrari A, Ferrari S, Frezza AM, Gasperoni S, Gelderblom H, Gil T, Grignani G, Gronchi A, Haas RL, Hassan B, Hohenberger P, Issels R, Joensuu H, Jones RL, Judson I, Jutte P, Kaal S, Kasper B, Kopeckova K, Krakorova DA, Le Cesne A, Lugowska I, Merimsky O, Montemurro M, Pantaleo MA, Piana R, Picci P, Piperno-Neumann S, Pousa AL, Reichardt P, Robinson MH, Rutkowski P, Safwat AA, Schoffski P, Sleijfer S, Stacchiotti S, Sundby Hall K, Unk M, Van Coevorden F, van der Graaf WTA, Whelan J, Wardelmann E, Zaikova O, Blay JY, Committee EG, Euracan (2018) Gastrointestinal stromal tumours: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 29:iv68-iv78
8.
go back to reference Novitsky YW, Kercher KW, Sing RF, Heniford BT (2006) Long-term outcomes of laparoscopic resection of gastric gastrointestinal stromal tumors. Ann Surg 243:738CrossRef Novitsky YW, Kercher KW, Sing RF, Heniford BT (2006) Long-term outcomes of laparoscopic resection of gastric gastrointestinal stromal tumors. Ann Surg 243:738CrossRef
9.
go back to reference Koh Y-X, Chok A-Y, Zheng H-L, Tan C-S, Chow PK, Wong W-K, Goh BK (2013) A systematic review and meta-analysis comparing laparoscopic versus open gastric resections for gastrointestinal stromal tumors of the stomach. Ann Surg Oncol 20:3549–3560CrossRef Koh Y-X, Chok A-Y, Zheng H-L, Tan C-S, Chow PK, Wong W-K, Goh BK (2013) A systematic review and meta-analysis comparing laparoscopic versus open gastric resections for gastrointestinal stromal tumors of the stomach. Ann Surg Oncol 20:3549–3560CrossRef
10.
go back to reference Di Vita M, Zanghì A, Cavallaro A, Cardì F, Uhlig M, Ursi P, Lo Menzo E, Panebianco V, Cappellani A (2019) Gastric GIST and prognostic models. Which is the best to predict survival after surgery. Ann Ital Chir 90:31–40PubMed Di Vita M, Zanghì A, Cavallaro A, Cardì F, Uhlig M, Ursi P, Lo Menzo E, Panebianco V, Cappellani A (2019) Gastric GIST and prognostic models. Which is the best to predict survival after surgery. Ann Ital Chir 90:31–40PubMed
11.
go back to reference Hsiao C-Y, Yang C-Y, Lai I-R, Chen C-N, Lin M-T (2015) Laparoscopic resection for large gastric gastrointestinal stromal tumor (GIST): intermediate follow-up results. Surg Endosc 29:868–873CrossRef Hsiao C-Y, Yang C-Y, Lai I-R, Chen C-N, Lin M-T (2015) Laparoscopic resection for large gastric gastrointestinal stromal tumor (GIST): intermediate follow-up results. Surg Endosc 29:868–873CrossRef
12.
go back to reference Khoo CY, Goh BKP, Eng AKH, Chan WH, Teo MCC, Chung AYF, Ong HS, Wong WK (2017) Laparoscopic wedge resection for suspected large (>/=5 cm) gastric gastrointestinal stromal tumors. Surg Endosc 31:2271–2279CrossRef Khoo CY, Goh BKP, Eng AKH, Chan WH, Teo MCC, Chung AYF, Ong HS, Wong WK (2017) Laparoscopic wedge resection for suspected large (>/=5 cm) gastric gastrointestinal stromal tumors. Surg Endosc 31:2271–2279CrossRef
13.
go back to reference Lian X, Feng F, Guo M, Cai L, Liu Z, Liu S, Xiao S, Zheng G, Xu G, Zhang H (2017) Meta-analysis comparing laparoscopic versus open resection for gastric gastrointestinal stromal tumors larger than 5 cm. BMC Cancer 17:760CrossRef Lian X, Feng F, Guo M, Cai L, Liu Z, Liu S, Xiao S, Zheng G, Xu G, Zhang H (2017) Meta-analysis comparing laparoscopic versus open resection for gastric gastrointestinal stromal tumors larger than 5 cm. BMC Cancer 17:760CrossRef
14.
go back to reference Lin J, Huang C, Zheng C, Li P, Xie J, Wang J, Lu J (2014) Laparoscopic versus open gastric resection for larger than 5 cm primary gastric gastrointestinal stromal tumors (GIST): a size-matched comparison. Surg Endosc 28:2577–2583CrossRef Lin J, Huang C, Zheng C, Li P, Xie J, Wang J, Lu J (2014) Laparoscopic versus open gastric resection for larger than 5 cm primary gastric gastrointestinal stromal tumors (GIST): a size-matched comparison. Surg Endosc 28:2577–2583CrossRef
15.
go back to reference Yu M, Wang DC, Wei J, Lei YH, Fu ZJ, Yang YH (2021) Meta-analysis on the efficacy and safety of laparoscopic surgery for large gastric gastrointestinal stromal tumors. Am Surg 87:450–457CrossRef Yu M, Wang DC, Wei J, Lei YH, Fu ZJ, Yang YH (2021) Meta-analysis on the efficacy and safety of laparoscopic surgery for large gastric gastrointestinal stromal tumors. Am Surg 87:450–457CrossRef
16.
go back to reference Sanchez-Hidalgo JM, Duran-Martinez M, Molero-Payan R, Rufian-Pena S, Arjona-Sanchez A, Casado-Adam A, Cosano-Alvarez A, Briceno-Delgado J (2018) Gastrointestinal stromal tumors: a multidisciplinary challenge. World J Gastroenterol 24:1925–1941CrossRef Sanchez-Hidalgo JM, Duran-Martinez M, Molero-Payan R, Rufian-Pena S, Arjona-Sanchez A, Casado-Adam A, Cosano-Alvarez A, Briceno-Delgado J (2018) Gastrointestinal stromal tumors: a multidisciplinary challenge. World J Gastroenterol 24:1925–1941CrossRef
17.
go back to reference Dematteo RP, Gold JS, Saran L, Gonen M, Liau KH, Maki RG, Singer S, Besmer P, Brennan MF, Antonescu CR (2008) Tumor mitotic rate, size, and location independently predict recurrence after resection of primary gastrointestinal stromal tumor (GIST). Cancer 112:608–615CrossRef Dematteo RP, Gold JS, Saran L, Gonen M, Liau KH, Maki RG, Singer S, Besmer P, Brennan MF, Antonescu CR (2008) Tumor mitotic rate, size, and location independently predict recurrence after resection of primary gastrointestinal stromal tumor (GIST). Cancer 112:608–615CrossRef
18.
go back to reference Dematteo RP, Ballman KV, Antonescu CR, Maki RG, Pisters PW, Demetri GD, Blackstein ME, Blanke CD, von Mehren M, Brennan MF, Patel S, McCarter MD, Polikoff JA, Tan BR, Owzar K, American College of Surgeons Oncology Group Intergroup Adjuvant GST (2009) Adjuvant imatinib mesylate after resection of localised, primary gastrointestinal stromal tumour: a randomised, double-blind, placebo-controlled trial. Lancet 373:1097–1104CrossRef Dematteo RP, Ballman KV, Antonescu CR, Maki RG, Pisters PW, Demetri GD, Blackstein ME, Blanke CD, von Mehren M, Brennan MF, Patel S, McCarter MD, Polikoff JA, Tan BR, Owzar K, American College of Surgeons Oncology Group Intergroup Adjuvant GST (2009) Adjuvant imatinib mesylate after resection of localised, primary gastrointestinal stromal tumour: a randomised, double-blind, placebo-controlled trial. Lancet 373:1097–1104CrossRef
19.
go back to reference Casali PG, Le Cesne A, Poveda Velasco A, Kotasek D, Rutkowski P, Hohenberger P, Fumagalli E, Judson IR, Italiano A, Gelderblom H, Adenis A, Hartmann JT, Duffaud F, Goldstein D, Broto JM, Gronchi A, Dei Tos AP, Marreaud S, van der Graaf WT, Zalcberg JR, Litiere S, Blay JY (2015) Time to definitive failure to the first tyrosine kinase inhibitor in localized GI stromal tumors treated with imatinib as an adjuvant: a European Organisation for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group Intergroup Randomized Trial in Collaboration With the Australasian Gastro-Intestinal trials group, UNICANCER, French Sarcoma Group, Italian Sarcoma Group, and Spanish Group for Research on Sarcomas. J Clin Oncol 33:4276–4283CrossRef Casali PG, Le Cesne A, Poveda Velasco A, Kotasek D, Rutkowski P, Hohenberger P, Fumagalli E, Judson IR, Italiano A, Gelderblom H, Adenis A, Hartmann JT, Duffaud F, Goldstein D, Broto JM, Gronchi A, Dei Tos AP, Marreaud S, van der Graaf WT, Zalcberg JR, Litiere S, Blay JY (2015) Time to definitive failure to the first tyrosine kinase inhibitor in localized GI stromal tumors treated with imatinib as an adjuvant: a European Organisation for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group Intergroup Randomized Trial in Collaboration With the Australasian Gastro-Intestinal trials group, UNICANCER, French Sarcoma Group, Italian Sarcoma Group, and Spanish Group for Research on Sarcomas. J Clin Oncol 33:4276–4283CrossRef
Metadata
Title
Is minimally invasive surgery for large gastric GIST actually safe? A comparative analysis of short- and long-term outcomes
Authors
Andrew B. Crocker
Eduardo A. Vega
Onur C. Kutlu
Omid Salehi
Sebastian Mellado
Mu Li
Olga Kozyreva
Claudius Conrad
Publication date
21-03-2022
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 9/2022
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-022-09066-4

Other articles of this Issue 9/2022

Surgical Endoscopy 9/2022 Go to the issue
Webinar | 06-02-2024 | 20:00 (CET)

Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions

Severe pain is the most common symptom of chronic pancreatitis. In this webinar, experts share the latest insights in pain management for chronic pancreatitis patients. Experts from a range of disciplines discuss pertinent cases and provide practical suggestions for use within clinical practice.

Sponsored by: Viatris

Developed by: Springer Healthcare