Efficacy of laparoscopic or open surgery for gastrointestinal stromal tumors and effects of different risk level on prognosis

Abstract

Objective To compare the efficacy of laparoscopic or open surgery for gastrointestinal stromal tumors (GISTs) and investigate effects of different risk level on prognosis. Methods The retrospective cohort study was adopted. The clinical data of 192 patients with GISTs who were admitted to Zhongshan Hospital of Fudan University from January 2008 to December 2013 were collected. Among the 192 patients, 88 undergoing laparoscopic surgeries were allocated into the laparoscopic surgery group, 104 patients undergoing open surgeries were allocated into the open surgery group. The following indicators were observed: (1) operative status: surgical procedure, operation time, volume of intraoperative blood loss. (2) Status of postoperative recovery: time of gastrointestinal function recovery, time of drainage tube removal, complications and duration of hospital stay. (3) Follow-up status. (4) Prognosis of patients in different risk level. The follow-up using outpatient examination and telephone interview was performed to assess patients′ survival, tumor recurrence and metastasis until June 2015. Measurement data with normal distribution were presented as ±s and comparison between groups was evaluated by the t test. Comparison of count data was analyzed by the chi-square test. The Kaplan-Meier method was used to draw survival curve and calculate the overall survival rate and relapse-free survival rate. Results (1) Operative status: of the 88 patients in the laparoscopic surgery group, 1 underwent laparoscopic wedge gastrectomy+ cholecystectomy+ appendectomy, 6 underwent laparoscopic wedge gastrectomy+ cholecystectomy, 14 underwent laparoscopic assisted partial gastrectomy, 67 underwent laparoscopic wedge gastrectomy. Of the 104 patients in the open surgery group, 1 underwent partial gastrectomy+ splenectomy, 2 underwent partial gastrectomy combined with distal pancreatectomy+ splenectomy, 2 underwent total gastrectomy, 7 underwent distal subtotal gastrectomy, 7 underwent wedge gastrectomy+ partial or total adjacent organ resection, 8 underwent proximal subtotal gastrectomy, 8 underwent wedge gastrectomy+ cholecystectomy, 69 underwent wedge gastrectomy. The operation time and volume of intraoperative blood loss were (105±33)minutes and (43±16)mL in the laparoscopic surgery group, (121±52)minutes and (199±81) mL in the open group, respectively, with statistically significant differences between the 2 groups (t=-2.104, 2.632, P 0.05). (3) Follow-up status: Of the 192 patients, 149 received follow-ups. Of 88 patients in the laparoscopic surgery group, 68 were followed up for an average time of 39 months. Of 104 patients in the open surgery group, 81 were followed up for an average time of 51 months. During the follow-up, tumor recurrence rate in the laparoscopic surgery group and open surgery group was respectively 8.8%(6/68) and 21.0%(17/81), with no statistically significant difference between the 2 groups (χ2=1.888, P>0.05 ). Postoperative 1-, 3-, 5 year survival rates were 98.5%, 92.9%, 87.4% and 91.7%, 85.2%, 76.9% in the laparoscopic surgery group and open surgery group, respectively, with no statistically significant difference between the 2 groups (χ2=1.967, P>0.05). (4) Prognosis of patients in different risk level: of the 149 who received the follow-up, the tumor recurrence rate of patients in low, intermediate and high recurrence risk was 7.0%(5/71), 13.6%(6/44) and 35.3%(12/34), respectively, with a statistically significant difference among the above indexes (χ2=14.637, P 0.05). Five-year relapse-free survival rate of low, intermediate and high risk patients was 94.2%, 80.0% and 61.8% respectively, with a statistically significant difference (χ2=13.547, P 0.05). Conclusions Compared to open resection, laparoscopic GISTs resection offers better short-term outcomes, however, the two surgical techniques offer equal long-term outcomes. Patients of high risk have poor prognosis. Key words: Gastrointestinal stromal tumors; Gastrectomy; Open surgery; Laparoscopy; Prognosis