Laparoscopic Versus Open Resection Of Gastric Gastrointestinal Stromal Tumors

Objective: Gastric stromal tumor (GST) is the most common solidtumors derived from mesenchymal tissue in the gastrointestinal tract,accounting for all gastrointestinal stromal tumors in60%-70%. GST hasspecial biology behavior, rarely metastasizes to lymph nodes, and has thepotentially malignant. Malignant risk has been shown to be dominatedprimarily by factors of mitotic index, size, and capsule integrity. Initialsurgery to ensure negative margins, local resection (R0resection) is expectedto be radical. With the laparoscopic technique has become more sophisticated,especially the development of laparoscopic instruments, including ultrasonicscalpel and a variety of linear stapler, which has greatly promoted theapplication of laparoscopy in the treatment of gastric stromal tumors.Laparoscopic wedge resection and laparoscopic-assisted gastrectomytreatment of gastric stromal tumor in the radical and security are stillcontroversial. In this study, to explore the radical and safety of laparoscopicresection of Gastric Stromal Tumors, we compared clinical data oflaparoscopic treatment of patients with clinical data of open treatment ofpatients.Methods: Collected clinical information from46cases of GST patients,who underwent Laparoscopic wedge resection and laparoscopic-assistedgastrectomy resection in the Fourth Hospital of Hebei Medical University inJanuary2009to December2011. These patients were then compared with acohort of46cases of GST patients treated by open, who were matched inrespect of gender, age, body mass index, hemoglobin, total protein, albumin,history of abdominal surgery, preoperative adjuvant chemotherapy, range ofresection, tumor location, tumor size, CD117staining and risk stratification.The intraoperative data (Operation time, blood loss), postoperative data (postoperative defecation time, postoperative hospital stay, perioperativecomplications, perioperative mortality and radical degree) and follow-up data(the dropout rate, recurrence rate, metastatic rate and mortality) werecompared. Statistical methods: the measurement data are expressed as mean±standard deviation (x±s), using paired t-test for analysis while theenumeration data using the χ2test for analysis. The data was statisticallyanalyzed by a=0.05. Various indicators were analyzed by using the SPSS17statistical package for analysis.Results: The46patients treated via laparotomy, including25cases oflaparoscopic wedge resection,21cases of laparoscopic-assisted gastrectomyresection, and all of them postoperative pathological diagnosis were gastricstromal tumor and also resection margin were negative, to achieve R0resection.1Laparoscopic group and open group compared to the perioperativecomplications (0/46vs.2/46), perioperative mortality(0/46vs.1/46), R0resection (46/46vs.46/46), the dropout rate (0vs.0), recurrence ormetastasis rate (2.2%vs.4.4%), mortality (0%vs.2.2%) there were nosignificant difference (P>0.05).2The blood loss, postoperative defecation time, postoperative hospital stay forthe laparoscopic group were respectively25.98±25.92ml,2.93±1.04days,7.59±1.57days significantly lower than77.46±71.31ml,4.11±1.18days,11.13±5.76days for the Open group(P<0.05).3Operative times for the laparoscopic group compared to open group wassignificantly longer (135.07±55.59min vs.112.22±53.47min, P<0.05).Conclusion: Compared with open, laparoscopic surgery time longer, butradical resection and security was no significant difference. Laparoscopicsurgical treatment of gastric stromal tumors can reduce the psychologicalburden of patients, and with less trauma and quicker recovery, shorter hospitalstay. When the tumor size and location of a suitable, complete capsule, nosurrounding tissue adhesion or invasion, we can give priority to thelaparoscopic surgical resection of gastric stromal tumor.