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Published in: Annals of Surgical Oncology 9/2014

01-09-2014 | Bone and Soft Tissue Sarcomas

Open Versus Minimally Invasive Resection of Gastric GIST: A Multi-Institutional Analysis of Short- and Long-Term Outcomes

Authors: Danielle A. Bischof, MD, Yuhree Kim, MD, MPH, Rebecca Dodson, MD, M. Carolina Jimenez, Ramy Behman, MD, Andrei Cocieru, MD, Dan G. Blazer III, FACS, MD, Sarah B. Fisher, MD, Malcolm H. Squires III, MD, MS, David A. Kooby, MD, Shishir K. Maithel, MD, FACS, Ryan T. Groeschl, MD, T. Clark Gamblin, MD, FACS, Todd W. Bauer, MD, FACS, Paul J. Karanicolas, MD, PhD, Calvin Law, MD, MPH, Fayez A. Quereshy, MD, MBA, Timothy M. Pawlik, MD, MPH, PhD, FACS

Published in: Annals of Surgical Oncology | Issue 9/2014

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Abstract

Background

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. Overall surgical experience with minimally invasive surgery (MIS) has increased; however, published reports on MIS resection of GIST are limited to small, single-institution experiences.

Methods

A total of 397 patients who underwent open surgery (n = 230) or MIS (n = 167) for a gastric GIST between 1998 and 2012 were identified from a multicenter database. The impact of MIS approach on recurrence and survival was analyzed using propensity-score matching by comparing clinicopathologic factors between patients who underwent MIS versus open resection.

Results

There were 19 conversions (10 %) to open; the most common reasons for conversion were tumor more extensive than anticipated (26 %) and unclear anatomy (21 %). On multivariate analysis, smaller tumor size and higher body mass index (BMI) were associated with receipt of MIS. In the propensity-matched cohort (n = 248), MIS resection was associated with decreased length of stay (MIS, 3 days vs open, 8 days) and fewer ≥ grade 3 complications (MIS, 3 % vs open, 14 %) compared with open surgery. High rates of R0 resection and low rates of tumor rupture were seen in both groups. After propensity-score matching, there was no difference in recurrence-free or overall survival comparing the MIS and the open group (both p > 0.05).

Conclusions

An MIS approach for gastric GIST was associated with low morbidity and a high rate of R0 resection. The long-term oncological outcome following MIS was excellent, and therefore the MIS approach should be considered the preferred approach for gastric GIST in well-selected patients.
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Metadata
Title
Open Versus Minimally Invasive Resection of Gastric GIST: A Multi-Institutional Analysis of Short- and Long-Term Outcomes
Authors
Danielle A. Bischof, MD
Yuhree Kim, MD, MPH
Rebecca Dodson, MD
M. Carolina Jimenez
Ramy Behman, MD
Andrei Cocieru, MD
Dan G. Blazer III, FACS, MD
Sarah B. Fisher, MD
Malcolm H. Squires III, MD, MS
David A. Kooby, MD
Shishir K. Maithel, MD, FACS
Ryan T. Groeschl, MD
T. Clark Gamblin, MD, FACS
Todd W. Bauer, MD, FACS
Paul J. Karanicolas, MD, PhD
Calvin Law, MD, MPH
Fayez A. Quereshy, MD, MBA
Timothy M. Pawlik, MD, MPH, PhD, FACS
Publication date
01-09-2014
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 9/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-3733-3

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