Surgical treatment of gastric stromal tumors: laparoscopic versus open approach


COD: 02_2017_12_2611 Categorie: ,

Monica Ortenzi, Roberto Ghiselli, Luca Cardinali, Mario Guerrieri

Ann. Ital. Chir., 2017 88, 2: 163-169

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AIM: Gastrointestinal stromal tumors (GIST) are quite rare tumors, but yet they are the most common mesenchymal
lesions of gastrointestinal tract. Their outmost frequent origin site is stomach and presently surgical resection is the mainstay
in the treatment of gastric non metastatic GIST. Their peculiar characteristic of growth and poor metastatic tendency
make this tumors particularly prone to be managed by minimally invasive technique.
Presenting our experience we want show the feasibility and safeness of laparoscopic approach for gastric GIST and its
benefits versus traditional open surgery and pointing out short term and long terms outcomes.
PATIENTS AND METHODS: In our series we included 60 patients who underwent surgery for gastric GIST from 2004 to
2014 at Clinica Chirurgica of Università Politecnica delle Marche. Patients were divided in two group according with
surgical approach (open or laparoscopic). Criteria of exclusion were metastatic disease and palliative purpose of surgical
resection. All patients underwent endoscopic ultrasonography, fine needle aspiration, TC/MRI or PET before surgery.
However most of the definitive diagnosis were postoperative. CD117 and CD34 immunohistochemical positivity were
considered suggestive for GIST. Tumors were classified in four different prognostic groups according with pathological findings
(size and mitotic count) as reported in Fletcher classification. None of the patients received Imatinib before surgery.
All patients underwent follow-up with Computerized Tomography (TC) and/or Magnetic Resonance (MRI) repeated every
year (mean 51.98 ± 35.68 months).
RESULTS: We performed open surgery on 22 patients (36.7%) and laparoscopic wedge resection on 38 patients (63.33%);
one of these underwent robotic wedge resection by da the da Vinci® surgical system.
The median age at diagnosis was 64 years (range= 45-71).
Patients with gastric GIST presented with various symptoms, including fatigue secondary to anemia, intraluminal gastrointestinal
bleeding, abdominal pain, abdominal mass, vomiting and syncope.
In 26 patients (43.3%) gastric GISTs were detected incidentally during abdominal exploration, endoscopy, or radiologic
imaging. Tumor dimensional difference between the two groups was not significant (mean 4.75 cm, range= 2-13).
Operation time was significantly lower in laparoscopic approach (82.4 versus 117.8 min). We did not experience of
intraoperative or post-operative complications in laparoscopic group. Conversely 4 patients of open group were transfused
for anemia. In our series we didn’t observe recurrence or metastasis at mean follow up period of (range= 49-120 months).
CONCLUSIONS: Laparoscopic surgery is a minimally invasive approach to the treatment of GISTs and offers many advantages
such as short hospital stay and low morbidity.
In the meantime oncological outcomes of laparoscopy for gastric GIST, assessed as tumor free resection margins and recurrence
rate, are comparable to traditional open strategy.