| Objectives:1. Evaluate the short-term perioperative achievements and treatment effect of laparoscopic gastrointestinal stromal tumor (GIST) resection, including the surgical feasibility, safety as well as radical resection degree and short-term prognosis, by comparing with the traditional laparotomy resection for gastrointestinal stromal tumor;2. Discuss the current NCCN operation indications for laparoscopic gastric resection of gastrointestinal stromal tumor and manage to improve it by promoting possible new criterions:3. Summarize the clinical data of gastrointestinal stromal tumors for the newly built database, intended for long-term recording and update of cases and close follow-up in the future.Methods:Search for stromal cases through the digital database in the medical records department and record associated ones (2002.1-2013.3) by prior designed sheets covering the entire information of perioperative session (patient demographics, preoperative exams, intraoperative information, pathology report, and postoperative recovery). The clinical characteristics were further sum-up for general knowledge and the incoming retrospective study and analysis. All cases enrolled were subdivided into laparoscopic group and laparotomy group, the perioperative characteristics and surgical outcomes of which were analyzed in a retrospective fashion and further compared. All data was displayed as ’x±s’. Student’s t-test, Chi-square test, Fisher’s exact test and one way ANOVA were used for statistical analysis based on data type respectively in SPSS19.0with a=0.05. P value of <0.05indicated statistical significance.Results:1.825cases of stromal tumor were retrieved after searching, including317cases of stomach (38.2%),169cases of small intestine (20.6%),67cases of duodenum (18.5%),67cases of esophagus (8.2%),47cases of abdominal cavity/omentum (5.7%),24cases of rectum and anal tube (2.9%),4cases of colon (0.5%), and other48cases (5.8%). The gastrointestinal stromal tumors accounted for88.4%of all stromal tumors, among which commonly seen were gastric, small intestinal and duodenal stromal tumors (77.3%). The typical clinical manifestations for gastric gastrointestinal stromal tumor were abdominal discomfort (44.7%). GI bleeding (32.4%), abdominal mass (9.2%), nausea and acid regurgitation (3%), dysphagia (1%) and others (2.5%). certain number of patients presented with no symptoms (7.2%).2. Of the87patients included,31patients underwent laparoscopic gastric resection while the remaining56the laparotomy gastric resection for gastric gastrointestinal stromal tumor.1). Both groups shared no statistical significance on age (p=0.507), tumor location (cardia and fundus p=0.934, corpus p=0.589, pylorus p=0.614), perioperative mortality rate (laparoscopy group0%vs. laparotomy group0%), and both achieved100%R0radical resection with negative gross and microscopic margin while maintaining tumor integrity.2). Generally, compared to the laparotomy group, the laparoscopy group managed to shorten significantly the operating time (122.8±39.5min vs.148.0±49.6min, p=0.001), reduce blood loss (90.2±87.2ml vs.227.0±260.8ml, p=0.006), facilitate postoperative defecation (2.6±1.0d vs.3.6±1.1d. p=0.000), and speed-up post-surgical recovery (length of stay6.9±1.9d vs.10.5±3.8d, p=0.000), while100%maintaining tumor integrity (tumor rupture:0in laparoscopy group vs.1in laparotomy group) without arousal of perioperative complication (0case in laparoscopy group vs.5cases in laparotomy group), promising a sound short-term (14±9.2months) follow-up outcome (0%recurrence/metastasis).3). More thoroughly, with regard to GISTs (<2cm) located near cardia and fundus, post-surgical length of stay was greatly reduced in laparoscopic group (5.5±1.4d vs.8.5±2.1d, p=0.024), however, analysis showed no significance in operating time, blood loss or postoperative defecation, indicating equal advantage of laparoscopy over laparotomy with operating time slightly lengthened (150.8min vs.132.5min, p=0.566) in former group. Further, laparoscopic gastric resection presented vast advantage for2-5cm GISTs resection in the same location in operating time (106.5±29.9min vs.143.9±50.1min, p=0.037), blood loss (82.7±80.5ml vs.200.3±153.4ml, p=0.029) and postoperative length of stay (7.5±1.2d vs.10.1±2.6d, p=0.004). Perioperative complications were significantly decreased in laparoscopic gastric resection (0case in laparoscopy group vs.2cases in laparotomy group) in0-10cm GISTs around gastric corpus while no other significance was seen in operating time, blood loss and postoperative defecation, rendering laparoscopic gastric GIST resection the same as safe, radical and feasible as traditional laparotomy.Conclusions:Based on our current studies, laparoscopic gastric resection is well indicated for0-5cm GISTs near cardia and fundus region as well as0-10cm GISTs located around stomach corpus, which, to a certain extent, is a bold expansion of the current NCCN guidelines (2012) for GIST surgical intervention. With experienced hands and operation techniques, not to mention the strict following of operation indications, laparoscopic resection of gastric GISTs will promise a better future as minimal invasive surgery, with shorter operating time, less trauma, faster recovery and a sound short-term prognosis. |
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