Safety and Efficacy of Laparoscopic Resection for Gastric Stromal Tumors: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 LIANG Jiwang ¹ , ZHENG Zhichao ¹ , ZHANG Tao ¹ , ZHAO Yan ¹ , WANG Yi ² , LIU Yong ¹

1. Department of Third Surgery, Liaoning Cancer Hospital & Institute, Shenyang 110042, China;2. Department of Anesthesiology, Liaoning Cancer Hospital & Institute, Shenyang 110042, China;

Corresponding author：

LIANG Jiwang, Email: liangjiwang1985@163.com

Keywords：

Gastric stromal tumor; Laparoscopy; Open resection; Meta-analysis; Systematic review

DOI：

10.7507/1672-2531.20110140

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Objective 　To assess the safety and efficacy of laparoscopic resection for gastric stromal tumors.
Methods 　The Literature published before November of 2010 was searched in PubMed, EMbase, Wiley Online Library, MEDLINE, CNKI, VIP, and CBM to identify the randomized controlled trials (RCTs) or quasi-RCTs about laparoscopic versus open resection for gastric stromal tumors. The literature was screened according to the inclusive and exclusive criteria by two reviewers independently, and the methodology quality was evaluated after abstracting the data, then the RevMan 5.0 software was used for Meta-analyses.
Results 　Four quasi-RCTs and eight CCTs involving 496 patients were included. The results of Meta-analyses showed that, compared with the open resection surgery, the laparoscopic resection surgery significantly reduced the hospitalization duration (MD= –2.81, 95%CI –4.51 to –1.11), and the incidence of recurrence and metastasis (OR=0.36, 95%CI 0.13 to 1.01). No significant differences were found between the two groups in operation time, amount of bleeding, postoperative first flatus and oral intake, and total complication rate (P gt;0.05).
Conclusion 　Laparoscopic resection surgery is safe to treat the patients with gastric stromal tumors, which may reduce the hospitalization duration and the incidence of recurrence and metastasis. Due to the poor quality and small sample size of included trials, more well-designed RCTs should be performed.

Citation： LIANG Jiwang,ZHENG Zhichao,ZHANG Tao,ZHAO Yan,WANG Yi,LIU Yong. Safety and Efficacy of Laparoscopic Resection for Gastric Stromal Tumors: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2011, 11(7): 819-825. doi: 10.7507/1672-2531.20110140 Copy

1.	1 Miettinen M, Lasota J. Gastrointestinal stromal tumors--definition, clinical, histological, immunohistochemical,and molecular genetic features and differential diagnosis. Virchows Arch , 2001, 438(1): 1-12.
2.	2 Gelen T, Elpek GO, Aksoy NH, et al . p27 labeling index and proliferation in gastrointestinal stromal tumors:correlations with clinicopathologic factors and recurrence. Jpn J Clin Oncol , 2003, 33(7): 346-352.
3.	3 D'amato G, Steinert DM, Mcauliffe JC, et al . Update on the biology and therapy of gastrointestinal stromal tumors. Cancer Control , 2005, 12(1): 44-56.
4.	4 Rossi CR, Mocellin S, Mencarelli R, et al . Gastrointestinal stromal tumors:from a surgical to a molecular approach. Int J Cancer , 2003, 107(2): 171-176.
5.	5 Joensuu H, Fletcher C, Dimitrijevic S, et al . Management of malignant gastrointestinal stromal tumours. Lancet Oncol , 2002, 3(11): 655-664.
6.	6 Matthews BD, Walsh RM, Kercher KW, et al . Laparoscopic vs open resection of gastric stromal tumors. Surg Endosc , 2002, 16(5): 803-807.
7.	7 Catena F, Di BM, Fusaroli P, et al . Laparoscopic treatment of gastric gist:report of 21 cases and literature's review. J Gastrointest Surg , 2008, 12(3): 561-568.
8.	8 Wu JM, Yang CY, Wang MY, et al . Gasless laparoscopy-assisted versus open resection for gastrointestinal stromal tumors of the upper stomach:preliminary results. J Laparoendosc Adv Surg Tech , 2010, 20(9): 725-729.
9.	9 Nishimura J, Nakajima K, Omori T, et al . Surgical strategy for gastric gastrointestinal stromal tumors: laparoscopic vs . open resection. Surg Endosc , 2007, 21(6): 875-878.
10.	10 Sarela AI. Entirely laparoscopic radical gastrectomy for adenocarcinoma: lymph node yield and resection margins. Surg Endosc , 2009, 23(1): 153-160.
11.	11 Goh BK, Chow PK, Chok AY, et al . Impact of the introduction of laparoscopic wedge resection as a surgical option for suspected small/medium-sized gastrointestinal stromal tumors of the stomach on perioperative and oncologic outcomes. World J Surg , 2010, 34(8): 1847-1852.
12.	12 Silberhumer GR, Hufschmid M, Wrba F, et al . Surgery for gastrointestinal stromal tumors of the stomach. J Gastrointest Surg , 2009, 13(7): 1213-1219.
13.	13 Ishikawa K, Inomata M, Etoh T, et al . Long-term outcome of laparoscopic wedge resection for gastric submucosal tumor compared with open wedge resection. Surg Laparosc Endosc Percutan Tech , 2006, 16(2): 82-85.
14.	14 Pitsinis V, Khan AZ, Cranshaw I, et al . Single center experience of laparoscopic vs . Open Resection for Gastrointestinal Stromal Tumors of the Stomach. Hepatogastroenterology , 2007, 54(74): 606-608.
15.	20 Schulz KF, Chalmers I, Hayes RJ, et al . Empirical evidence of bias. dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA , 1995, 273(5): 408-412.
16.	21 Casali PG, Jost L, Reichardt P, et al . Gastrointestinal stromal tumours: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol , 2009, 20(Suppl 4): 64-67.
17.	22 Tryggvason G, Gislason HG, Magnusson MK, et al . Gastrointestinal stromal tumors in iceland. The Icelandic Gist Study, a Population-Based Incidence and Pathologic Risk Stratification Study. Int J Cancer , 2005, 117(2): 289-293.
18.	23 Lukaszczyk JJ, Preletz RJ. Laparoscopic resection of benign stromal tumor of the stomach. J Laparoendosc Surg , 1992, 2(6): 331-334.
19.	24 Nguyen SQ, Divino CM, Wang JL, et al . Laparoscopic management of gastrointestinal stromal tumors. Surg Endosc , 2006, 20(5): 713-716.
20.	25 Mochizuki Y, Kodera Y, Fujiwara M, et al . Laparoscopic wedge resection for gastrointestinal stromal tumors of the stomach: initial experience. Surg Today , 2006, 36(4): 341-347.
21.	26 Cheng HL, Lee WJ, Lai IR, et al . Laparoscopic wedge resection of benign gastric tumor. Hepatogastroenterology , 1999, 46(27): 2100-2104.
22.	27 Hindmarsh A, Koo B, Lewis MP, et al . Laparoscopic resection of gastric gastrointestinal stromal tumors. Surg Endosc , 2005, 19(8): 1109-1112.
23.	28 Novitsky YW, Kercher KW, Sing RF, et al . Long-term outcomes of laparoscopic resection of gastric gastrointestinal stromal tumors. Ann Surg , 2006, 243(6): 738-745.
24.	王港, 付卫, 王德臣, 等. 腹腔镜与开腹胃间质瘤契形切除的临床对比研究. 中国微创外科杂志, 2010, 10(2): 126-129.
25.	许东, 吴硕东, 于宏. 胃间质瘤的腹腔镜手术与开腹手术的临床对比研究. 生物医学工程与临床, 2009, 13(2): 123-125.
26.	周迪, 张勇, 龚伟, 等. 腹腔镜联合胃镜行胃间质瘤切除术的临床分析. 腹腔镜外科杂志, 2009, 14(7): 526-529.
27.	李河, 麦劲壮, 方积乾, 等. Meta分析中漏斗图的绘制. 循证医学, 2007, 7(2): 101-104, 106.
28.	康德英, 洪旗, 刘关键, 等. Meta分析中发表性偏倚的识别与处理. 中国循证医学杂志, 2003, 3(1): 45-49.
29.	钱锋, 余佩武, 王自强, 等. 腹腔镜胃间质瘤切除术30例. 中华胃肠外科杂志, 2007, 10(1): 33-34.

1. 1 Miettinen M, Lasota J. Gastrointestinal stromal tumors--definition, clinical, histological, immunohistochemical,and molecular genetic features and differential diagnosis. Virchows Arch , 2001, 438(1): 1-12.
2. 2 Gelen T, Elpek GO, Aksoy NH, et al . p27 labeling index and proliferation in gastrointestinal stromal tumors:correlations with clinicopathologic factors and recurrence. Jpn J Clin Oncol , 2003, 33(7): 346-352.
3. 3 D'amato G, Steinert DM, Mcauliffe JC, et al . Update on the biology and therapy of gastrointestinal stromal tumors. Cancer Control , 2005, 12(1): 44-56.
4. 4 Rossi CR, Mocellin S, Mencarelli R, et al . Gastrointestinal stromal tumors:from a surgical to a molecular approach. Int J Cancer , 2003, 107(2): 171-176.
5. 5 Joensuu H, Fletcher C, Dimitrijevic S, et al . Management of malignant gastrointestinal stromal tumours. Lancet Oncol , 2002, 3(11): 655-664.
6. 6 Matthews BD, Walsh RM, Kercher KW, et al . Laparoscopic vs open resection of gastric stromal tumors. Surg Endosc , 2002, 16(5): 803-807.
7. 7 Catena F, Di BM, Fusaroli P, et al . Laparoscopic treatment of gastric gist:report of 21 cases and literature's review. J Gastrointest Surg , 2008, 12(3): 561-568.
8. 8 Wu JM, Yang CY, Wang MY, et al . Gasless laparoscopy-assisted versus open resection for gastrointestinal stromal tumors of the upper stomach:preliminary results. J Laparoendosc Adv Surg Tech , 2010, 20(9): 725-729.
9. 9 Nishimura J, Nakajima K, Omori T, et al . Surgical strategy for gastric gastrointestinal stromal tumors: laparoscopic vs . open resection. Surg Endosc , 2007, 21(6): 875-878.
10. 10 Sarela AI. Entirely laparoscopic radical gastrectomy for adenocarcinoma: lymph node yield and resection margins. Surg Endosc , 2009, 23(1): 153-160.
11. 11 Goh BK, Chow PK, Chok AY, et al . Impact of the introduction of laparoscopic wedge resection as a surgical option for suspected small/medium-sized gastrointestinal stromal tumors of the stomach on perioperative and oncologic outcomes. World J Surg , 2010, 34(8): 1847-1852.
12. 12 Silberhumer GR, Hufschmid M, Wrba F, et al . Surgery for gastrointestinal stromal tumors of the stomach. J Gastrointest Surg , 2009, 13(7): 1213-1219.
13. 13 Ishikawa K, Inomata M, Etoh T, et al . Long-term outcome of laparoscopic wedge resection for gastric submucosal tumor compared with open wedge resection. Surg Laparosc Endosc Percutan Tech , 2006, 16(2): 82-85.
14. 14 Pitsinis V, Khan AZ, Cranshaw I, et al . Single center experience of laparoscopic vs . Open Resection for Gastrointestinal Stromal Tumors of the Stomach. Hepatogastroenterology , 2007, 54(74): 606-608.
15. 20 Schulz KF, Chalmers I, Hayes RJ, et al . Empirical evidence of bias. dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA , 1995, 273(5): 408-412.
16. 21 Casali PG, Jost L, Reichardt P, et al . Gastrointestinal stromal tumours: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol , 2009, 20(Suppl 4): 64-67.
17. 22 Tryggvason G, Gislason HG, Magnusson MK, et al . Gastrointestinal stromal tumors in iceland. The Icelandic Gist Study, a Population-Based Incidence and Pathologic Risk Stratification Study. Int J Cancer , 2005, 117(2): 289-293.
18. 23 Lukaszczyk JJ, Preletz RJ. Laparoscopic resection of benign stromal tumor of the stomach. J Laparoendosc Surg , 1992, 2(6): 331-334.
19. 24 Nguyen SQ, Divino CM, Wang JL, et al . Laparoscopic management of gastrointestinal stromal tumors. Surg Endosc , 2006, 20(5): 713-716.
20. 25 Mochizuki Y, Kodera Y, Fujiwara M, et al . Laparoscopic wedge resection for gastrointestinal stromal tumors of the stomach: initial experience. Surg Today , 2006, 36(4): 341-347.
21. 26 Cheng HL, Lee WJ, Lai IR, et al . Laparoscopic wedge resection of benign gastric tumor. Hepatogastroenterology , 1999, 46(27): 2100-2104.
22. 27 Hindmarsh A, Koo B, Lewis MP, et al . Laparoscopic resection of gastric gastrointestinal stromal tumors. Surg Endosc , 2005, 19(8): 1109-1112.
23. 28 Novitsky YW, Kercher KW, Sing RF, et al . Long-term outcomes of laparoscopic resection of gastric gastrointestinal stromal tumors. Ann Surg , 2006, 243(6): 738-745.
24. 王港, 付卫, 王德臣, 等. 腹腔镜与开腹胃间质瘤契形切除的临床对比研究. 中国微创外科杂志, 2010, 10(2): 126-129.
25. 许东, 吴硕东, 于宏. 胃间质瘤的腹腔镜手术与开腹手术的临床对比研究. 生物医学工程与临床, 2009, 13(2): 123-125.
26. 周迪, 张勇, 龚伟, 等. 腹腔镜联合胃镜行胃间质瘤切除术的临床分析. 腹腔镜外科杂志, 2009, 14(7): 526-529.
27. 李河, 麦劲壮, 方积乾, 等. Meta分析中漏斗图的绘制. 循证医学, 2007, 7(2): 101-104, 106.
28. 康德英, 洪旗, 刘关键, 等. Meta分析中发表性偏倚的识别与处理. 中国循证医学杂志, 2003, 3(1): 45-49.
29. 钱锋, 余佩武, 王自强, 等. 腹腔镜胃间质瘤切除术30例. 中华胃肠外科杂志, 2007, 10(1): 33-34.

Chinese Journal of Evidence-Based Medicine

Safety and Efficacy of Laparoscopic Resection for Gastric Stromal Tumors: A Systematic Review

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