Long-term Outcomes Of Laparoscopic Resection Research Articles

Is laparoscopic approach as treatment of large gastric GIST acceptable?

Laparoscopic surgery is widely used for small gastric gastrointestinal stromal tumors (GISTs) (≤ 5cm) but remains a controversial approach for larger gastric GISTs (> 5cm). This study aims to compare short- and long-term outcomes of laparoscopic resection in comparison with open resection for gastric GISTs measuring over 5cm. All patients receiving surgery for gastric GIST > 5cm between 2000 and 2021 in a single tertiary hospital were included. Data were collected from prospectively maintained records. Kaplan-Meier method and log rank test were used to compare survival outcomes. Among 108 included patients, 59 patients had minimally invasive (MI) surgery (54.6%) whereas 49 patients had open surgery (46.4%). The rate of overall postoperative morbidity was 14.8% and the median length was significantly shorter in the MI group [4 (range 2-30) vs. 7 (range 4-33) days; P = 0.007]. The overall R0 resection rate was 98.2% and the rate of tumor rupture was 13%, not different between the two groups. Recurrence occurred in 24% of the whole population without any difference between groups (20.3% vs. 28.7%, p = 0.31). Minimally invasive surgery was not found as a negative prognostic disease-free survival factor. Laparoscopic surgery could be a safe and feasible alternative to open surgery in large gastric GIST, bringing the benefits of minimally invasive surgery without compromising oncologic results.

Gastric gastrointestinal stromal tumors: clinical features and short- and long-term outcomes of laparoscopic resection.

IntroductionAlthough minimally invasive techniques are currently recognized as effective and validated treatment for small gastric gastrointestinal stromal tumors (GISTs), the role of laparoscopy is not yet established, especially in the institutions that have less experience in minimally invasive surgery.AimTo evaluate the outcomes of laparoscopic treatment of gastric gastrointestinal stromal tumors compared to the results obtained in a group of patients treated with conventional surgery.Material and methodsA retrospective analysis of data collected for a group of 68 patients treated for gastric GIST in the period from 2002 to 2017 was performed. Forty-six patients were treated laparoscopically (group 1) and 22 patients underwent conventional surgery (group 2). The analyzed medical data included clinical and pathomorphological features of removed tumors, perioperative parameters as well as short and long-term results of surgical treatment.ResultsHistopathological examination confirmed radical resection for all patients. No deaths were reported in the 30-day post-operative period. Patients in group 1 had significantly shorter length of hospital stay (3 vs. 9 days), less intra-operative blood loss (25 vs. 175 ml) and fewer perioperative complications (13% vs. 41%) compared to group 2. The mean post-operative follow-up was 57 months. During this period, four patients died for reasons unrelated to the primary disease. None of the patients who underwent a laparoscopic procedure had a recurrence of the tumor in the follow-up period.ConclusionsLaparoscopy in the treatment of gastric GISTs has unquestionable advantages, including decreased blood loss, reduced risk of complications, and shorter hospital stay.

Treatment Results of Small Intestinal Gastrointestinal Stromal Tumors Less than 10 cm in Diameter: A Comparison between Laparoscopy and Open Surgery

PurposeTo evaluate the technical feasibility and oncologic safety, we assessed the short-term and long-term outcomes of laparoscopic resection of the small bowel gastrointestinal stromal tumors smaller than 5 cm by comparing those of open surgery by subgroup analysis based on tumor size.Materials and MethodsFrom November 1993 to January 2011, 41 laparoscopic resections were performed among the 95 patients who underwent resection of small intestine ≤10 cm in diameter. The clinicopathologic features, perioperative outcomes, recurrences and survival of these patients were reviewed.ResultsThe postoperative morbidity rates were comparable between the 2 groups. Laparoscopic surgery group showed significantly shorter operative time (P=0.004) and duration of postoperative hospital stay (P<0.001) than open surgery group and it was more apparent in the smaller tumor size group. There were no difference in 5-year survival for the laparoscopic surgery versus open surgery groups (P=0.163), and in 5-year recurrence-free survival (P=0.262). The subgroup analysis by 5 cm in tumor size also shows no remarkable differences in 5-year survival and recurrence-free survival.ConclusionsLaparoscopic resection for small bowel gastrointestinal stromal tumors of size less than 10 cm has favorable short-term postoperative outcomes, while achieving comparable oncologic results compared with open surgery. Thus, laparoscopic approach can be recommended as a treatment modality for patients with small bowel gastrointestinal stromal tumors less than 10 cm in diameter.

Results of laparoscopic treatment of rectal cancer: analysis of 520 patients

To evaluate short- and long-term outcomes of laparoscopic resection of rectal carcinoma in curative intent. Within a subgroup analysis of a multicentre study, initiated by the "Laparoscopic Colorectal Surgery Study Group (LCSSG)", 520 patients with rectal cancer were included in a prospective, clinical observational study. One hundred and ninety patients underwent an abdominoperineal resection (APR) and 330 patients an anterior resection (AR) of the rectum. The demographic parameters, intraoperative complication rates, morbidity and mortality rates were comparable in both groups. In patients undergoing AR a trend towards limited oncologic radicality, and a significant increase in the anastomotic leak rate related to the distance of the tumour from the anal verge were observed. Calculated survival data revealed stage-related survival rates for UICC stages I, II and III of 82.0%, 68.8% and 63.3%, respectively. While APR is highly suited to the laparoscopic approach, laparoscopic AR cannot at present be generally recommended.