Laparoscopic vs Open Treatment for Gastric and Non-Gastric Gastrointestinal Stromal Tumors: a Two-Center Experience
Authors:   Department of Surgery, Cittiglio-Angera Hospital - ASST Sette Laghi, Varese, Pappalardo Vincenzo , Lianos Georgios D. ,   Department of Surgery, University Hospital of Ioannina, Ioannina, Greece, Morabito Marika ,   General, Emergency, and Transplant Surgery Unit, University of Insubria, ASST Settelaghi, Varese, Italy, Gianazza Simone ,   General, Emergency, and Transplant Surgery Unit, University of Insubria, ASST Settelaghi, Varese, Italy, Cassinotti Elisa ,   Chirurgia Generale, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy, Frattini Francesco ,   Division of Surgery, Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy, Pino Antonella ,   Division of Surgery, Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy, Rausei Stefano ,   Department of Surgery, Cittiglio-Angera Hospital - ASST Sette Laghi, Varese, Carcano Giulio ,   Department of Surgery, University Hospital of Ioannina, Ioannina, Greece
Published: September 2023

We retrospectively reviewed the medical records of 109 patients who underwent curative laparoscopic or open resection for different types of gastrointestinal stromal tumors (GIST). Only primary GIST patients who did not receive preoperative chemotherapy or oral imatinib treatment were included in the analysis. We divided the patients into 2 groups according to the surgical approach:a laparoscopic group (LAP) and a laparotomic group (OPEN). Our aim was to confirm the feasibility and safety of laparoscopic surgery for GISTs that differed in size and location, and to assess its long-term oncologic outcome in terms of overall survival (OS) and disease-free survival (DFS). Furthermore, we performed a surgical short-term outcome analysis. The two groups did not differ with respect to age at operation, gender, BMI or comorbidities. Even the NIH and AFIP risk classifications were not significantly different between the two groups. Furthermore, in our analysis, there was no significant difference in mean tumor size or location between the two groups. Wedge resection was the most frequently performed procedure. The conversion rate was 7.8%. The operative time was 194.75 (60- 350) min for the open group and 181.70 (57-480) min for the laparoscopic group. Our data clearly indicated that the long-term oncologic outcome and DFS of laparoscopic resection were not inferior to those of traditional open operations and laparoscopic resection was still feasible in cases with large tumors: the median size of the tumor was 4.5 cm (3-25) and the tumor was larger than 4.5 cm in 47.7% of the cases in the LAP group. With regard to short-term outcomes, our study demonstrated that the LAP group had fewer complications, faster gastrointestinal recovery, reduced use of analgesic drugs and shorter postoperative hospital stay (each p<0.05). In conclusion, our experience confirms that GISTs are very uncommon cancers for which the prognosis is closely related to size, localization and class of risk. In light of our clinical data, laparoscopic resection for gastric and non-gastric GISTs is a safe, feasible and oncologically correct procedure. The most important advantage of this technique is that it ensures a better postoperative outcome compared with open surgery, without worsening the prognosis.