The Safety And Efficacy Of Laparoscopic Resection Versus Open Resection For The Larger(5-10cm) Gastric Stromal Tumors:a Meta-analysis

Objective:To evaluate the safety and efficacy of laparoscopic-assisted resection(LAP)versus open surgery for the large(5-10cm)gastric gastrointestinal stromal tumors(GISTs).Methods:Database including PubMed,Embase,Cochrane Library,Google Scholar,CBM,CNKI,WanFang date and VIP date were searched with “gastric/gastrointestinal stromal tumor”“GIST/GISTs”“laparoscopic /laparoscopy resection”“open resection”before January 2018 for comparison laparoscopic and open surgery for large(5-10cm)gastric stromal tumors in the study.The Mate-analysis was conducted by RevMan5.3 software.Draw out a forest map with surgery time,intraoperative blood loss,postoperative fluid diet time,postoperative hospital stay,postoperative total complication rate,postoperative overall recurrence rate,5-year disease-free survival rate and The 5-year overall survival rate was used as a comprehensive evaluation of the efficacy of the two surgical procedures.The odds ratio(OR value),mean difference(MD),standard mean difference(SMD)and 95% confidence interval(95% CI)were used to evaluate the efficacy and the results were finally concluded.Results:Seven studies were included for meta-analysis,involving 440 patients with GIST,of whom 217 cases with LAP and 223 cases with Open surgery for treatment.Meta-analysis results showed that,compared to open surgery,LAP experienced lower intraoperative blood loss(WMD=-40.57,95%CI=-68.89~-12.25,P<0.05),earlier postoperative feeding and shorter length of hospital stay(WMD=-0.75,95%CI=-1.25 ~-0.26,P<0.05;WMD=-2.38,95%CI=-3.09~-1.66)(P<0.05).There was no significant difference in operative time and postoperative complication rate between two groups(WMD=15.62,95%CI=-34.03 ~ 65.26;OR=0.56,95%CI=0.31 ~ 1.01)(P>0.05).In the long-term efficacy,although the 5-year disease-free survival rate is higher in the LAP versus open surgery(OR=2.66,95%CI=1.23~5.75,P<0.05),however,there was no significant difference in the overall recurrence rate and 5-year overall survival rate between the two groups(OR=0.58,95%CI=0.27~1.23;OR=1.86,95%CI=0.80~4.35)(P>0.05).Conclusion:The operation time of the laparoscopic group was similar to the open group.However,the amount of bleeding in the laparoscopic group was significantly reduced compared to open group.The postoperative feeding time and postoperative hospital stay were significantly shorter than those in the open group.The disease-free survival rate was higher after 5 years.There were no significant differences in the long-term outcomes of postoperative complications,overall recurrence,and 5-year overall survival.LAP is a safe and feasible treatment method for the larger(5-10cm)gastric stromal tumors,which can obtain a similar or better clinical effect than open surgery.