| Objective:To compare and investigate the recent clinical effects for primary localized gastric stromal tumors through laparoscopic surgery and open surgery and discuss the feasibility of laparoscopic surgery for localized gastric stromal tumor.Methods:Retrospective analysis of clinical data of 57 cases of gastric stromal tumor patients undergoing operation in Qilu Hospital of Shandong University from April 2012 to April 2015 within 31 laparoscopic surgeries and open 27 surgeries. Inclusion criteria: ① Tumor diameter≥ 1cm or≤ 10cm. ② Distance from tumor to pylorus or cadia≥ 3cm (measured by endoscopy and endoscopic ultrasound examination) without requirement for removing and rebuilding the pylorus or cadia. ③ Not combined with other organ resection. ④ No previous history of abdominal surgery.⑤ Diagnosed as gastric GIST postoperatively by pathological and immunohistochemistry method. In the 58 cases, there are 31 cases of laparoscopic surgeries (referred to as laparoscopic group), including the minimum tumor diameter of lcm, the maximum diameter of 8.5 cm and 10 cases in which the diameter of tumors are equal to or greater than 5cm, with no conversion to open surgery. While there are (abbreviated laparotomy group) 27 cases of open surgeries, including the minimum tumor diameter of lcm, the maximum diameter of 8cm and 12 cases in which the diameter of tumors are equal to or greater than 5cm. Two groups of patients had no statistically significant difference (Table 1, P> 0.05) in gender, age, tumor size and tumor location and the two groups were comparable.(Table 1)Compare and investigate operative time, blood loss, postoperative first flatus (referred to exhaust time), postoperative hospital stay and postoperative complications between two groups. Compare and evaluate curative effect between patients with GIST in different parts of the stomach and in different sizes undergoing laparoscopic surgery and open surgery.Results:No conversion to open surgery in 31 laparoscopic surgeries 1.Statistic data of patients with GIST in different parts of the stomach and in different sizes undergoing laparoscopic surgery and open surgery was as follows in Table 2. The results showed: ① To patients with gastric GIST smaller than 5cm, the Laparoscopic group had shorter postoperative hospital stay than the open group(P<0.05) but had no significant difference in operative time, blood loss and exhaust time(P>0.05). ② To patients with gastric GIST equal to or greater than 5cm, two groups had no significant difference in operative time, blood loss, exhaust time and postoperative hospital stay(P>0.05).③ To patients with GIST on the anterior wall, the greater curvature and the lesser curvature of the stomach, the Laparoscopic group had shorter postoperative hospital stay than the open group(P<0.05) but had no significant difference in operative time, blood loss and exhaust time(P>0.05).④ To patients with GIST on the posterior wall of stomach, the Laparoscopic group had shorter operative time than the open group(P<0.05) but had no significant difference in postoperative hospital stay, blood loss and exhaust time(P>0.05). 2.Statistic data of patients in two groups totally was as follows in Table 3. The results showed:Totally, the Laparoscopic group had shorter operative time and postoperative hospital stay than the open group(P<0.05) but had no significant difference in blood loss, exhaust time and postoperative complications (P>0.05). Conclusions:To patients with gastric GIST smaller than 5cm or GIST on the anterior wall, the greater curvature and the lesser curvature of the stomach, Laparoscopic surgery has faster recovery, less trauma, shorter hospital stay and other advantages over open surgery. To patients with gastric GIST of which the diameter is equal to or greater than 5cm while less than or equal to 8.8cm and with no effect to pylorus and cadia, Laparoscopic surgery had better short-term curative effect than open surgery under proper patient selection. |
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