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Published in: BMC Surgery 1/2022

01-12-2022 | Gastrointestinal Stromal Tumor | Research

Hand-assisted laparoscopic resection versus total laparoscopic gastric surgery for primary gastric gastrointestinal stromal tumors (GISTs): an analysis from a high-volume institution

Authors: Ya-Jun Zhao, Yong-Qiang Qiu, Li-Ying Zhong, Wen-Ze Zheng, Lv-Ping Zhuang, Zhong Wei, Zhong-Liang Ning

Published in: BMC Surgery | Issue 1/2022

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Abstract

Background

Laparoscopic resection of gastric gastrointestinal stromal tumors (GISTs) is technically feasible and associated with favorable outcomes. We compared the clinical efficacy of hand-assisted laparoscopic surgery (HLS) and total laparoscopic surgery (TLS) for gastric GISTs.

Methods

We retrospectively analyzed the clinical data of 69 consecutive patients diagnosed with a gastric GIST in a tertiary referral teaching hospital from December 2016 to December 2020. Surgical outcomes were compared between two groups.

Results

Fifty-three patients (TLS group: n = 36; HLS group: n = 17) were included. The mean age was 56.9 and 58.1 years in the TLS and HLS groups, respectively. The maximum tumor margin was significantly shorter in the HLS group than in the TLS group (2.3 ± 0.9. vs. 3.0 ± 0.8 cm; P = 0.004). The operative time of the HLS group was significantly shorter than that of the TLS group (70.6 ± 19.1 min vs. 134.4 ± 53.7 min; P < 0.001). The HLS group had less intraoperative blood loss, a shorter time to first flatus, and a shorter time to fluid diet than the TLS group (P < 0.05). No significant difference was found between the groups in the incidence or severity of complications within 30 days after surgery. Recurrence or metastasis occurred in four cases (HLS group; n = 1; TLS group; n = 3).

Conclusions

This study demonstrated that compared with TLS, HLS for gastric GISTs has the advantages of simpler operation, shorter operative time, and faster postoperative recovery.
Literature
1.
go back to reference Mehren M, Kane III JM, Bui MM, Edwin; C, Connelly M, Dry S. Gastrointestinal Stromal Tumors (GISTs) Version 1.2021. Fort Washington: NCCN. 2021;[2021-01]. Mehren M, Kane III JM, Bui MM, Edwin; C, Connelly M, Dry S. Gastrointestinal Stromal Tumors (GISTs) Version 1.2021. Fort Washington: NCCN. 2021;[2021-01].
2.
go back to reference Chen QF, Huang CM, Lin M, Lin JX, Lu J, Zheng CH, et al. Short- and long-term outcomes of laparoscopic versus open resection for gastric gastrointestinal stromal tumors: a propensity score-matching analysis. Medicine (Baltimore). 2016;95(15): e3135.CrossRef Chen QF, Huang CM, Lin M, Lin JX, Lu J, Zheng CH, et al. Short- and long-term outcomes of laparoscopic versus open resection for gastric gastrointestinal stromal tumors: a propensity score-matching analysis. Medicine (Baltimore). 2016;95(15): e3135.CrossRef
3.
go back to reference De Vogelaere K, Van Loo I, Peters O, Hoorens A, Haentjens P, Delvaux G. Laparoscopic resection of gastric gastrointestinal stromal tumors (GIST) is safe and effective, irrespective of tumor size. Surg Endosc. 2012;26(8):2339–45.CrossRefPubMed De Vogelaere K, Van Loo I, Peters O, Hoorens A, Haentjens P, Delvaux G. Laparoscopic resection of gastric gastrointestinal stromal tumors (GIST) is safe and effective, irrespective of tumor size. Surg Endosc. 2012;26(8):2339–45.CrossRefPubMed
4.
go back to reference Chen K, Zhou YC, Mou YP, Xu XW, Jin WW, Ajoodhea H. Systematic review and meta-analysis of safety and efficacy of laparoscopic resection for gastrointestinal stromal tumors of the stomach. Surg Endosc. 2015;29(2):355–67.CrossRefPubMed Chen K, Zhou YC, Mou YP, Xu XW, Jin WW, Ajoodhea H. Systematic review and meta-analysis of safety and efficacy of laparoscopic resection for gastrointestinal stromal tumors of the stomach. Surg Endosc. 2015;29(2):355–67.CrossRefPubMed
5.
go back to reference Yano H, Kimura Y, Iwazawa T, Takemoto H, Imasato M, Monden T, et al. Hand-assisted laparoscopic surgery for a large gastrointestinal stromal tumor of the stomach. Gastric Cancer. 2005;8(3):186–92.CrossRefPubMed Yano H, Kimura Y, Iwazawa T, Takemoto H, Imasato M, Monden T, et al. Hand-assisted laparoscopic surgery for a large gastrointestinal stromal tumor of the stomach. Gastric Cancer. 2005;8(3):186–92.CrossRefPubMed
6.
go back to reference Gong JQ, Cao YK, Wang YH, Zhang GH, Wang PH, Luo GD. Learning curve for hand-assisted laparoscopic D2 radical gastrectomy. World J Gastroenterol. 2015;21(5):1606–13.CrossRefPubMedPubMedCentral Gong JQ, Cao YK, Wang YH, Zhang GH, Wang PH, Luo GD. Learning curve for hand-assisted laparoscopic D2 radical gastrectomy. World J Gastroenterol. 2015;21(5):1606–13.CrossRefPubMedPubMedCentral
7.
go back to reference Huang ZN, Huang CM, Zheng CH, Li P, Xie JW, Wang JB, Lin JX, Lu J, Chen QY, Cao LL, Lin M, Tu RH. Learning curve of the application of huang three-step maneuver in a laparoscopic spleen-preserving splenic hilar lymphadenectomy for advanced gastric cancer. Medicine (Baltimore). 2016;95(13): e3252.CrossRef Huang ZN, Huang CM, Zheng CH, Li P, Xie JW, Wang JB, Lin JX, Lu J, Chen QY, Cao LL, Lin M, Tu RH. Learning curve of the application of huang three-step maneuver in a laparoscopic spleen-preserving splenic hilar lymphadenectomy for advanced gastric cancer. Medicine (Baltimore). 2016;95(13): e3252.CrossRef
8.
go back to reference Kurta ML, Edwards RP, Moysich KB, Mcdonough K, Bertolet M, Weissfeld JL, et al. Prognosis and conditional disease-free survival among patients with ovarian cancer. J Clin Oncol. 2014;32(36):4102–12.CrossRefPubMedPubMedCentral Kurta ML, Edwards RP, Moysich KB, Mcdonough K, Bertolet M, Weissfeld JL, et al. Prognosis and conditional disease-free survival among patients with ovarian cancer. J Clin Oncol. 2014;32(36):4102–12.CrossRefPubMedPubMedCentral
9.
go back to reference Verweij J, Casali PG, Zalcberg J, LeCesne A, Reichardt P, Blay JY, et al. Progression-free survival in gastrointestinal stromal tumors with high-dose imatinib: randomised trial. Lancet. 2004;364(9440):1127–34.CrossRefPubMed Verweij J, Casali PG, Zalcberg J, LeCesne A, Reichardt P, Blay JY, et al. Progression-free survival in gastrointestinal stromal tumors with high-dose imatinib: randomised trial. Lancet. 2004;364(9440):1127–34.CrossRefPubMed
10.
go back to reference Joensuu H. Risk stratification of patients diagnosed with gastrointestinal stromal tumor. Hum Pathol. 2008;39(10):1411–9.CrossRefPubMed Joensuu H. Risk stratification of patients diagnosed with gastrointestinal stromal tumor. Hum Pathol. 2008;39(10):1411–9.CrossRefPubMed
11.
go back to reference Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol. 2002;33(5):459–65.CrossRefPubMed Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol. 2002;33(5):459–65.CrossRefPubMed
12.
go back to reference Heinrich MC, Corless CL, Duensing A, McGreevey L, Chen CJ, Joseph N, et al. PDGFRA activating mutations in gastrointestinal stromal tumors. Science. 2003;299(5607):708–10.CrossRefPubMed Heinrich MC, Corless CL, Duensing A, McGreevey L, Chen CJ, Joseph N, et al. PDGFRA activating mutations in gastrointestinal stromal tumors. Science. 2003;299(5607):708–10.CrossRefPubMed
13.
go back to reference Hirota S, Ohashi A, Nishida T, Isozaki K, Kinoshita K, Shinomura Y, et al. Gain-of-function mutations of platelet-derived growth factor receptor alpha gene in gastrointestinal stromal tumors. Gastroenterology. 2003;125(3):660–7.CrossRefPubMed Hirota S, Ohashi A, Nishida T, Isozaki K, Kinoshita K, Shinomura Y, et al. Gain-of-function mutations of platelet-derived growth factor receptor alpha gene in gastrointestinal stromal tumors. Gastroenterology. 2003;125(3):660–7.CrossRefPubMed
14.
go back to reference Bischof DA, Kim Y, Dodson R, Jimenez MC, Behman R, Cocieru A, et al. Conditional disease-free survival after surgical resection of gastrointestinal stromal tumors: a multi-institutional analysis of 502 patients. JAMA Surg. 2015;150(4):299–306.CrossRefPubMedPubMedCentral Bischof DA, Kim Y, Dodson R, Jimenez MC, Behman R, Cocieru A, et al. Conditional disease-free survival after surgical resection of gastrointestinal stromal tumors: a multi-institutional analysis of 502 patients. JAMA Surg. 2015;150(4):299–306.CrossRefPubMedPubMedCentral
15.
go back to reference Lukaszczyk JJ, Preletz RJ Jr. Laparoscopic resection of benign stromal tumor of the stomach. J Laparoendosc Surg. 1992;2(6):331–4.CrossRefPubMed Lukaszczyk JJ, Preletz RJ Jr. Laparoscopic resection of benign stromal tumor of the stomach. J Laparoendosc Surg. 1992;2(6):331–4.CrossRefPubMed
16.
go back to reference Dressler JA, Palazzo F, Berger AC, Stake S, Chaudhary A, Chojnacki KA, et al. Long-term functional outcomes of laparoscopic resection for gastric gastrointestinal stromal tumors. Surg Endosc. 2016;30(4):1592–8.CrossRefPubMed Dressler JA, Palazzo F, Berger AC, Stake S, Chaudhary A, Chojnacki KA, et al. Long-term functional outcomes of laparoscopic resection for gastric gastrointestinal stromal tumors. Surg Endosc. 2016;30(4):1592–8.CrossRefPubMed
18.
go back to reference Milone M, Elmore U, Musella M, Parise P, Zotti MC, Bracale U, et al. Safety and efficacy of laparoscopic wedge gastrectomy for large gastrointestinal stromal tumors. Eur J Surg Oncol. 2017;43(4):796–800.CrossRefPubMed Milone M, Elmore U, Musella M, Parise P, Zotti MC, Bracale U, et al. Safety and efficacy of laparoscopic wedge gastrectomy for large gastrointestinal stromal tumors. Eur J Surg Oncol. 2017;43(4):796–800.CrossRefPubMed
19.
go back to reference Yang Z, Feng X, Zhang P, Chen T, Qiu H, Zhou Z, et al. Clinicopathological features and prognosis of 276 cases of primary small (≤ 2 cm) gastric gastrointestinal stromal tumors: a multicenter data review. Surg Endosc. 2019;33(9):2982–90.CrossRefPubMed Yang Z, Feng X, Zhang P, Chen T, Qiu H, Zhou Z, et al. Clinicopathological features and prognosis of 276 cases of primary small (≤ 2 cm) gastric gastrointestinal stromal tumors: a multicenter data review. Surg Endosc. 2019;33(9):2982–90.CrossRefPubMed
20.
go back to reference Janczak D, Rać J, Pawłowski W, Dorobisz T, Ziomek A, Janczak D, et al. Management of gastrointestinal stromal tumors: a 10-year experience of a single surgical department. Adv Clin Exp Med. 2018;27(5):667–71.CrossRefPubMed Janczak D, Rać J, Pawłowski W, Dorobisz T, Ziomek A, Janczak D, et al. Management of gastrointestinal stromal tumors: a 10-year experience of a single surgical department. Adv Clin Exp Med. 2018;27(5):667–71.CrossRefPubMed
21.
go back to reference Lin J, Huang C, Zheng C, Li P, Xie J, Wang J, et al. Laparoscopic versus open gastric resection for larger than 5 cm primary gastric gastrointestinal stromal tumors (GIST): a size-matched comparison. Surg Endosc. 2014;28(9):2577–83.CrossRefPubMed Lin J, Huang C, Zheng C, Li P, Xie J, Wang J, et al. Laparoscopic versus open gastric resection for larger than 5 cm primary gastric gastrointestinal stromal tumors (GIST): a size-matched comparison. Surg Endosc. 2014;28(9):2577–83.CrossRefPubMed
22.
go back to reference Gong J, Cao Y, Li Y, Zhang G, Wang P, Luo G. Hand-assisted laparoscopic versus laparoscopy-assisted D2 radical gastrectomy: a prospective study. Surg Endosc. 2014;28(10):2998–3006.CrossRefPubMed Gong J, Cao Y, Li Y, Zhang G, Wang P, Luo G. Hand-assisted laparoscopic versus laparoscopy-assisted D2 radical gastrectomy: a prospective study. Surg Endosc. 2014;28(10):2998–3006.CrossRefPubMed
23.
go back to reference Dreifuss Nicolas H, Schlottmann F, Cubisino A, et al. Novel surgical approach for gastric gastrointestinal stromal tumor (GIST): Robotic single port partial gastrectomy. Surg Oncol. 2022;40: 101704.CrossRefPubMed Dreifuss Nicolas H, Schlottmann F, Cubisino A, et al. Novel surgical approach for gastric gastrointestinal stromal tumor (GIST): Robotic single port partial gastrectomy. Surg Oncol. 2022;40: 101704.CrossRefPubMed
24.
go back to reference Solaini L, Cavaliere D, Fico V, Milone M, De Pascale S, Desiderio J, Vitali G, Parisi A, Fumagalli Romario U, De Palma GD, D’Ugo D, Ercolani G. Open versus laparoscopic versus robotic gastric gastrointestinal stromal tumour resections: a multicentre cohort study. Int J Med Robot. 2021;17(2): e2198.PubMed Solaini L, Cavaliere D, Fico V, Milone M, De Pascale S, Desiderio J, Vitali G, Parisi A, Fumagalli Romario U, De Palma GD, D’Ugo D, Ercolani G. Open versus laparoscopic versus robotic gastric gastrointestinal stromal tumour resections: a multicentre cohort study. Int J Med Robot. 2021;17(2): e2198.PubMed
25.
go back to reference Chetta N, Picciariello A, Nagliati C, Balani A, Martines G. Surgical treatment of gastric GIST with acute bleeding using laparoscopic sleeve gastrectomy: a report of two cases. Clin Case Rep. 2019;7(4):776–81.CrossRefPubMedPubMedCentral Chetta N, Picciariello A, Nagliati C, Balani A, Martines G. Surgical treatment of gastric GIST with acute bleeding using laparoscopic sleeve gastrectomy: a report of two cases. Clin Case Rep. 2019;7(4):776–81.CrossRefPubMedPubMedCentral
26.
go back to reference Chetta N, Martines G, Picciariello A, Capuano P. Successful laparoscopic sleeve gastrectomy in emergency for a gastric gastrointestinal stomal tumor (GIST) with acute bleeding: a case report. Am J Case Rep. 2018;19:849–53.CrossRefPubMedPubMedCentral Chetta N, Martines G, Picciariello A, Capuano P. Successful laparoscopic sleeve gastrectomy in emergency for a gastric gastrointestinal stomal tumor (GIST) with acute bleeding: a case report. Am J Case Rep. 2018;19:849–53.CrossRefPubMedPubMedCentral
Metadata
Title
Hand-assisted laparoscopic resection versus total laparoscopic gastric surgery for primary gastric gastrointestinal stromal tumors (GISTs): an analysis from a high-volume institution
Authors
Ya-Jun Zhao
Yong-Qiang Qiu
Li-Ying Zhong
Wen-Ze Zheng
Lv-Ping Zhuang
Zhong Wei
Zhong-Liang Ning
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2022
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/s12893-022-01668-y

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