Top

Surgical Endoscopy

Published in:

01-08-2014

Long-term and surgical outcomes of laparoscopic surgery for gastric gastrointestinal stromal tumors

Authors: Michitaka Honda, Naoki Hiki, Souya Nunobe, Manabu Ohashi, Takashi Kiyokawa, Takeshi Sano, Toshiharu Yamaguchi

Published in: Surgical Endoscopy | Issue 8/2014

Abstract

Background

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. Surgical resection with a free margin is the gold standard treatment for these lesions.

Objective

The aim of this study was to evaluate the feasibility of performing laparoscopic resection for gastric GIST from the viewpoint of operative and long-term oncological outcomes.

Methods

Between 2005 and 2011, a total of 78 consecutive patients undergoing laparoscopic resection of gastric GISTs were enrolled in a retrospective single-center study. Patient and tumor characteristics, surgical procedures, risk classification, postoperative complications, mortality, recurrence, and survival time were collected from a database, and the descriptive statistics were estimated.

Results

Patients (N = 78; 32 males and 46 females) with a median age of 63 years (range 31–82) were evaluated. The tumors were located at the cardia (10.3 %), upper stomach (59.0 %), middle stomach (23.1), and lower stomach (7.7 %). The mean size of the tumors was 34.7 ± 12.1 mm. The laparoscopic procedures included wedge resection (92.3 %), such as laparoscopy and endoscopy cooperative surgery (51.3 %), and gastrectomy (7.7 %). All cases exhibited a pathologically negative margin. The mean operative time was 147.5 ± 63.8 min, and the mean estimated amount of blood loss was 17.8 ± 47.9 ml. The mean length of hospitalization was 9.4 ± 12.8 days. The incidence of perioperative complications higher than grade III was 2.6 %, including two cases of anastomotic leakage. Regarding risk classification, low, intermediate and high were observed in 61, 6, and 11 cases, respectively. During a mean follow-up period of 45.3 ± 18.5 months, one patient experienced local recurrence in the omentum. Meanwhile, four patients died due to other diseases; all other patients survived.

Conclusions

Adequate oncologic resection was achieved in all cases. Laparoscopic surgery is a feasible option for gastric GISTs <5 cm.

Kindblom LG, Remotti HE, Aldenborg F, Meis-Kindblom JM (1998) Gastrointestinal pacemaker cell tumor (GIPACT): gastrointestinal stromal tumors show phenotypic characteristics of the interstitial cells of Cajal. Am J Pathol 152:1259–1269PubMedCentralPubMed

Joensuu H, Fletcher C, Dimitrijevic S, Silberman S, Roberts P, Demetri G (2002) Management of malignant gastrointestinal stromal tumours. Lancet Oncol 3:655–664PubMedCrossRef

DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF (2000) Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 231:51–58PubMedCentralPubMedCrossRef

Sandvik OM, Søreide K, Kvaløy JT, Gudlaugsson E, Søreide JA (2011) Epidemiology of gastrointestinal stromal tumours: single-institution experience and clinical presentation over three decades. Cancer Epidemiol 35:515–520PubMedCrossRef

Burkill GJ, Badran M, Al-Muderis O, Meirion Thomas J, Judson IR, Fisher C, Moskovic EC (2003) Malignant gastrointestinal stromal tumor: distribution, imaging features, and pattern of metastatic spread. Radiology 226:527–532PubMedCrossRef

Dematteo RP, Gold JS, Saran L, Gönen 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 112:608–615PubMedCrossRef

Novitsky YW, Kercher KW, Sing RF, Heniford BT (2006) Long-term outcomes of laparoscopic resection of gastric gastrointestinal stromal tumors. Ann Surg 243:738–745PubMedCentralPubMedCrossRef

Gold JS, Gönen M, Gutiérrez A, Broto JM, García-del-Muro X, Smyrk TC, Maki RG, Singer S, Brennan MF, Antonescu CR, Donohue JH, DeMatteo RP (2009) Development and validation of a prognostic nomogram for recurrence-free survival after complete surgical resection of localised primary gastrointestinal stromal tumour: a retrospective analysis. Lancet Oncol 10:1045–1052PubMedCentralPubMedCrossRef

Catena F, Di Battista M, Fusaroli P, Ansaloni L, Di Scioscio V, Santini D, Pantaleo M, Biasco G, Caletti G, Pinna A (2008) Laparoscopic treatment of gastric GIST: report of 21 cases and literature’s review. J Gastrointest Surg 12:561–568PubMedCrossRef

10.

Das A, Wilson R, Biankin AV, Merrett ND (2009) Surgical therapy for gastrointestinal stromal tumours of the upper gastrointestinal tract. J Gastrointest Surg 13:1220–1225PubMedCrossRef

11.

Choi SM, Kim MC, Jung GJ, Kim HH, Kwon HC, Choi SR, Jang JS, Jeong JS (2007) Laparoscopic wedge resection for gastric GIST: long-term follow-up results. Eur J Surg Oncol 33:444–447PubMedCrossRef

12.

Kim KH, Kim MC, Jung GJ, Kim SJ, Jang JS, Kwon HC (2012) Long term survival results for gastric GIST: is laparoscopic surgery for large gastric GIST feasible? World J Surg Oncol 10:230PubMedCentralPubMedCrossRef

13.

Blay JY, Bonvalot S, Casali P et al (2005) GIST consensus meeting panelists (2005) Consensus meeting for the management of gastrointestinal stromal tumors. Report of the GIST Consensus Conference of 20–21 March 2004, under the auspices of ESMO. Ann Oncol 16:566–578PubMedCrossRef

14.

Hiki N, Yamamoto Y, Fukunaga T, Yamaguchi T, Nunobe S, Tokunaga M, Miki A, Ohyama S, Seto Y (2008) Laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor dissection. Surg Endosc 22:1729–1735PubMedCrossRef

15.

De Vogelaere K, Hoorens A, Haentjens P, Delvaux G (2013) Laparoscopic versus open resection of gastrointestinal stromal tumors of the stomach. Surg Endosc 27(5):1546–1554PubMedCrossRef

16.

Karakousis GC, Singer S, Zheng J, Gonen M, Coit D, DeMatteo RP, Strong VE (2011) Laparoscopic versus open gastric resections for primary gastrointestinal stromal tumors (GISTs): a size-matched comparison. Ann Surg Oncol 18:1599–1605PubMedCrossRef

17.

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 147:516–520PubMedCrossRef

18.

Sexton JA, Pierce RA, Halpin VJ, Eagon JC, Hawkins WG, Linehan DC, Brunt LM, Frisella MM, Matthews BD (2008) Laparoscopic gastric resection for gastrointestinal stromal tumors. Surg Endosc 22:2583–2587PubMedCrossRef

19.

Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O’Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW (2002) Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol 33:459–465PubMedCrossRef

20.

Wong NA, Young R, Malcomson RD, Nayar AG, Jamieson LA, Save VE, Carey FA, Brewster DH, Han C, Al-Nafussi A (2003) Prognostic indicators for gastrointestinal stromal tumours: a clinicopathological and immunohistochemical study of 108 resected cases of the stomach. Histopathology 43:118–126PubMedCrossRef

21.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCentralPubMedCrossRef

22.

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, Task Force NCCN (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):1–29

23.

Lai IR, Lee WJ, Yu SC (2006) Minimally invasive surgery for gastric stromal cell tumors: intermediate follow-up results. J Gastrointest Surg 10:563–566PubMedCrossRef

24.

Basu S, Mohandas KM, Peshwe H, Asopa R, Vyawahare M (2008) FDG-PET and PET/CT in the clinical management of gastrointestinal stromal tumor. Nucl Med Commun 29:1026–1039PubMedCrossRef

Title: Long-term and surgical outcomes of laparoscopic surgery for gastric gastrointestinal stromal tumors
Authors: Michitaka Honda
Naoki Hiki
Souya Nunobe
Manabu Ohashi
Takashi Kiyokawa
Takeshi Sano
Toshiharu Yamaguchi
Publication date: 01-08-2014
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 8/2014
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-014-3459-0

At a glance: The STEP trials

Springer Medicine

Long-term and surgical outcomes of laparoscopic surgery for gastric gastrointestinal stromal tumors

Abstract

Background

Objective

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Objective

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2014

Effects of mesenchymal stem cell and fibroblast coating on immunogenic potential of prosthetic meshes in vitro

Recurrences are common after endoscopic ampullectomy for adenoma in the familial adenomatous polyposis (FAP) syndrome

Comparative effects of gastric bypass and sleeve gastrectomy on plasma osteopontin concentrations in humans

Gender influence on long-term weight loss after three bariatric procedures: gastric banding is less effective in males in a retrospective analysis

FLS tasks can be used as an ergonomic discriminator between laparoscopic and robotic surgery

Impact of the alvarado score on the diagnosis of acute appendicitis: comparing clinical judgment, alvarado score, and a new modified score in suspected appendicitis: a prospective, randomized clinical trial