Update on Laparoscopic Treatment of Gastrointestinal Stromal Tumors

Abstract

Laparoscopic surgery and tyrosine kinase-inhibitor (TKI) therapy are frequently used to treat gastrointestinal stromal tumors (GISTs). The purpose of this review was to analyze the published data on minimally invasive treatment of GISTs, with special focus on tumor location and on the possible role of laparoscopy in association with imatinib mesylate therapy in the treatment of advanced forms. The MEDLINE® and Embase® databases were searched for potentially eligible English-language studies published through June 30, 2015. Laparoscopic surgery can be considered a treatment option for GISTs at all locations. Most gastric GISTs are suitable for laparoscopic wedge resection (44-100% in recent series). Gastric GISTs in difficult-to-treat areas may benefit from innovative approaches such as transgastric or intragastric resection. Few data are available for small-bowel and colonic GISTs, although laparoscopic resection complying with the oncologic principles seems feasible and safe with reported morbidity and mortality rates of 3.8-6.7% and 0%, respecively. Primary resection of large rectal GISTs carries a risk of recurrence up to 40%. To improve long-term results and reduce the invasiveness of surgery in this setting, as in other difficultto- treat areas, neoadjuvant imatinib therapy should be considered. In selected cases, the combination of imatinib mesylate therapy and laparoscopy can minimize surgical trauma. The appropriate adoption of laparoscopic surgery and TKI therapy can reduce surgical trauma and optimize long-term results.