Feasibility analysis of laparoscopic resection in treatment of gastric stromal tumors at difficult sites_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WU Hongxue , MA Shujin , XIANG Mingwei ,  TONG Shilun

Department of The First Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, P. R. China;

Corresponding author：

TONG Shilun, Email: tongshilun@163.com

Keywords：

gastric stromal tumor; difficult site; laparoscopy; imatinib

DOI：

10.7507/1007-9424.201903043

Video：

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Objective To investigate the feasibility and safety of laparoscopic resection in treatment of gastric stromal tumors at difficult sites.Methods A retrospective analysis of 64 cases of gastric stromal tumors at the difficult sites in Renmin Hospital of Wuhan University from January 2013 to October 2018 was performed. According to the patient’s surgical procedure, 64 cases were divided into two groups, there were 26 cases in the laparoscopic group and 38 cases in the open group. The clinical pathology data, surgical indexes, and follow-up results of the two groups were compared.Results All the operations were successfully completed, and the patients in the laparoscopic group did not conversate to open surgery. There were no complications such as postoperative hemorrhage, anastomotic leakage, cardia or pyloric stenosis, abdominal infection, and no positive margin and tumor rupture. The postoperative venting time, visual analogue scale of pain on 1 day after operation, and hospital stay in the laparoscopic group were better than those of the open group (P<0.05). There were no local recurrence cases in the two groups. In the open group, two cases of middle-high risk patients did not take imatinib according to the doctor’s advice and suffered from liver metastasis. In the laparoscopic group, one case of high-risk patient did not take medicine regularly and suffered from liver metastasis too. There was no significant difference in survival situation between the two groups (P>0.05).Conclusion Laparoscopic resection is safe and feasible for gastric stromal tumors with a diameter of less than 5 cm, it has shorter recover time and shorter hospital stay than open surgery, which can be clinically promoted.

Citation： WU Hongxue, MA Shujin, XIANG Mingwei, TONG Shilun. Feasibility analysis of laparoscopic resection in treatment of gastric stromal tumors at difficult sites. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(8): 934-938. doi: 10.7507/1007-9424.201903043 Copy

1.	Machado-Aranda D, Malamet M, Chang YJ, et al. Prevalence and management of gastrointestinal stromal tumors. Am Surg, 2009, 75(1): 55-60.
2.	Hirota S, Isozaki K, Moriyama Y, et al. Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Science, 1998, 279(5350): 577-580.
3.	Heinrich MC, Corless CL, Duensing A, et al. PDGFRA activating mutations in gastrointestinal stromal tumors. Science, 2003, 299(5607): 708-710.
4.	Katz SC, DeMatteo RP. Gastrointestinal stromal tumors and leiomyosarcomas. J Surg Oncol, 2008, 97(4): 350-359.
5.	Kukar M, Kapil A, Papenfuss W, et al. Gastrointestinal stromal tumors (GISTs) at uncommon locations: a large population based analysis. J Surg Oncol, 2015, 111(6): 696-701.
6.	Søreide K, Sandvik OM, Søreide JA, et al. Global epidemiology of gastrointestinal stromal tumours (GIST): a systematic review of population-based cohort studies. Cancer Epidemiol, 2016, 40: 39-46.
7.	Gheorghe M, Predescu D, Iosif C, et al. Clinical and therapeutic considerations of GIST. J Med Life, 2014, 7(2): 139-149.
8.	Lim KT, Tan KY. Current research and treatment for gastrointestinal stromal tumors. World J Gastroenterol, 2017, 23(27): 4856-4866.
9.	Garlipp B, Bruns CJ. State of the art in the treatment of gastrointestinal stromal tumors. Gastrointest Tumors, 2014, 1(4): 221-236.
10.	马宝庆, 薛建, 苏英锋. 腹腔镜联合胃镜与开腹手术治疗胃间质瘤临床比较研究. 中国普外基础与临床杂志, 2016, 23(4): 434-438.
11.	Inaba CS, Dosch A, Koh CY, et al. Laparoscopic versus open resection of gastrointestinal stromal tumors: survival outcomes from the NCDB. Surg Endosc, 2019, 33(3): 923-932.
12.	Loureiro Mde P, Almeida RA, Claus CM, et al. Laparoscopic resection of gastrointestinal stomal tumors (GIST). Arq Bras Cir Dig, 2016, 29(1): 1-4.
13.	Masoni L, Gentili I, Maglio R, et al. Laparoscopic resection of large gastric GISTs: feasibility and long-term results. Surg Endosc, 2014, 28(10): 2905-2910.
14.	El-Hanafy E, El-Hemaly M, Hamdy E, et al. Surgical management of gastric gastrointestinal stromal tumor: a single center experience. Saudi J Gastroenterol, 2011, 17(3): 189-193.
15.	Joensuu H. Risk stratification of patients diagnosed with gastrointestinal stromal tumor. Hum Pathol, 2008, 39(10): 1411-1419.
16.	杨弘鑫, 陈秀峰, 张波, 等. 217例胃间质瘤的临床特点与诊治. 中国普外基础与临床杂志, 2012, 19(9): 951-956.
17.	王峰, 宋鹏, 汪灏, 等. 284例胃间质瘤临床特征及预后分析. 中华普外科手术学杂志: 电子版, 2017, 11(2): 123-126.
18.	Kasetsermwiriya W, Nagai E, Nakata K, et al. Laparoscopic surgery for gastric gastrointestinal stromal tumor is feasible irrespective of tumor size. J Laparoendosc Adv Surg Tech A, 2014, 24(3): 123-129.
19.	Kim JJ, Lim JY, Nguyen SQ. Laparoscopic resection of gastrointestinal stromal tumors: does laparoscopic surgery provide an adequate oncologic resection? World J Gastrointest Endosc, 2017, 9(9): 448-455.
20.	Cao F, Li A, Li J, et al. Feasibility and safety of laparoscopic resection for gastric GISTs larger than 5 cm: results from a prospective study. Oncol Lett, 2015, 10(4): 2081-2086.
21.	Takahashi T, Nakajima K, Miyazaki Y, et al. Surgical strategy for the gastric gastrointestinal stromal tumors (GISTs) larger than5 cm: laparoscopic surgery is feasible, safe, and oncologically acceptable. Surg Laparosc Endosc Percutan Tech, 2015, 25(2): 114-118.
22.	De Vogelaere K, Van Loo I, Peters O, et al. Laparoscopic resection of gastric gastrointestinal stromal tumors (GIST) is safe and effective, irrespective of tumor size. Surg Endosc, 2012, 26(8): 2339-2345.
23.	Lin J, Huang C, Zheng C, 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): 2577-2583.
24.	Corless CL, Fletcher JA, Heinrich MC. Biology of gastrointestinal stromal tumors. J Clin Oncol, 2004, 22(18): 3813-3825.
25.	Miettinen M, Sobin LH, Sarlomo-Rikala M. Immunohistochemical spectrum of GISTs at different sites and their differential diagnosis with a reference to CD117(KIT). Mod Pathol, 2000, 13(10): 1134-1142.
26.	Rutkowski P, Gronchi A, Hohenberger P, et al. Neoadjuvant imatinib in locally advanced gastrointestinal stromal tumors (GIST): the EORTC STBSG experience. Ann Surg Oncol, 2013, 20(9): 2937-2943.
27.	Joensuu H, Eriksson M, Sundby Hall K, et al. One vs three years of adjuvant imatinib for operable gastrointestinal stromal tumor: a randomized trial. JAMA, 2012, 307(12): 1265-1272.

1. Machado-Aranda D, Malamet M, Chang YJ, et al. Prevalence and management of gastrointestinal stromal tumors. Am Surg, 2009, 75(1): 55-60.
2. Hirota S, Isozaki K, Moriyama Y, et al. Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Science, 1998, 279(5350): 577-580.
3. Heinrich MC, Corless CL, Duensing A, et al. PDGFRA activating mutations in gastrointestinal stromal tumors. Science, 2003, 299(5607): 708-710.
4. Katz SC, DeMatteo RP. Gastrointestinal stromal tumors and leiomyosarcomas. J Surg Oncol, 2008, 97(4): 350-359.
5. Kukar M, Kapil A, Papenfuss W, et al. Gastrointestinal stromal tumors (GISTs) at uncommon locations: a large population based analysis. J Surg Oncol, 2015, 111(6): 696-701.
6. Søreide K, Sandvik OM, Søreide JA, et al. Global epidemiology of gastrointestinal stromal tumours (GIST): a systematic review of population-based cohort studies. Cancer Epidemiol, 2016, 40: 39-46.
7. Gheorghe M, Predescu D, Iosif C, et al. Clinical and therapeutic considerations of GIST. J Med Life, 2014, 7(2): 139-149.
8. Lim KT, Tan KY. Current research and treatment for gastrointestinal stromal tumors. World J Gastroenterol, 2017, 23(27): 4856-4866.
9. Garlipp B, Bruns CJ. State of the art in the treatment of gastrointestinal stromal tumors. Gastrointest Tumors, 2014, 1(4): 221-236.
10. 马宝庆, 薛建, 苏英锋. 腹腔镜联合胃镜与开腹手术治疗胃间质瘤临床比较研究. 中国普外基础与临床杂志, 2016, 23(4): 434-438.
11. Inaba CS, Dosch A, Koh CY, et al. Laparoscopic versus open resection of gastrointestinal stromal tumors: survival outcomes from the NCDB. Surg Endosc, 2019, 33(3): 923-932.
12. Loureiro Mde P, Almeida RA, Claus CM, et al. Laparoscopic resection of gastrointestinal stomal tumors (GIST). Arq Bras Cir Dig, 2016, 29(1): 1-4.
13. Masoni L, Gentili I, Maglio R, et al. Laparoscopic resection of large gastric GISTs: feasibility and long-term results. Surg Endosc, 2014, 28(10): 2905-2910.
14. El-Hanafy E, El-Hemaly M, Hamdy E, et al. Surgical management of gastric gastrointestinal stromal tumor: a single center experience. Saudi J Gastroenterol, 2011, 17(3): 189-193.
15. Joensuu H. Risk stratification of patients diagnosed with gastrointestinal stromal tumor. Hum Pathol, 2008, 39(10): 1411-1419.
16. 杨弘鑫, 陈秀峰, 张波, 等. 217例胃间质瘤的临床特点与诊治. 中国普外基础与临床杂志, 2012, 19(9): 951-956.
17. 王峰, 宋鹏, 汪灏, 等. 284例胃间质瘤临床特征及预后分析. 中华普外科手术学杂志: 电子版, 2017, 11(2): 123-126.
18. Kasetsermwiriya W, Nagai E, Nakata K, et al. Laparoscopic surgery for gastric gastrointestinal stromal tumor is feasible irrespective of tumor size. J Laparoendosc Adv Surg Tech A, 2014, 24(3): 123-129.
19. Kim JJ, Lim JY, Nguyen SQ. Laparoscopic resection of gastrointestinal stromal tumors: does laparoscopic surgery provide an adequate oncologic resection? World J Gastrointest Endosc, 2017, 9(9): 448-455.
20. Cao F, Li A, Li J, et al. Feasibility and safety of laparoscopic resection for gastric GISTs larger than 5 cm: results from a prospective study. Oncol Lett, 2015, 10(4): 2081-2086.
21. Takahashi T, Nakajima K, Miyazaki Y, et al. Surgical strategy for the gastric gastrointestinal stromal tumors (GISTs) larger than5 cm: laparoscopic surgery is feasible, safe, and oncologically acceptable. Surg Laparosc Endosc Percutan Tech, 2015, 25(2): 114-118.
22. De Vogelaere K, Van Loo I, Peters O, et al. Laparoscopic resection of gastric gastrointestinal stromal tumors (GIST) is safe and effective, irrespective of tumor size. Surg Endosc, 2012, 26(8): 2339-2345.
23. Lin J, Huang C, Zheng C, 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): 2577-2583.
24. Corless CL, Fletcher JA, Heinrich MC. Biology of gastrointestinal stromal tumors. J Clin Oncol, 2004, 22(18): 3813-3825.
25. Miettinen M, Sobin LH, Sarlomo-Rikala M. Immunohistochemical spectrum of GISTs at different sites and their differential diagnosis with a reference to CD117(KIT). Mod Pathol, 2000, 13(10): 1134-1142.
26. Rutkowski P, Gronchi A, Hohenberger P, et al. Neoadjuvant imatinib in locally advanced gastrointestinal stromal tumors (GIST): the EORTC STBSG experience. Ann Surg Oncol, 2013, 20(9): 2937-2943.
27. Joensuu H, Eriksson M, Sundby Hall K, et al. One vs three years of adjuvant imatinib for operable gastrointestinal stromal tumor: a randomized trial. JAMA, 2012, 307(12): 1265-1272.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Feasibility analysis of laparoscopic resection in treatment of gastric stromal tumors at difficult sites

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