Surgery For Gastric Gastrointestinal Stromal Tumors Research Articles

Utilization of Neoadjuvant Therapy in Gastrointestinal Stromal Tumors of the Stomach: Analysis of the 2006–2018 National Cancer Database

BackgroundNeoadjuvant tyrosine kinase inhibitor (TKI) therapy has reduced tumor burden and improved survival in both primary and recurrent gastrointestinal stromal tumors (GISTs). However, no clear guidelines exist on optimal patient selection for neoadjuvant therapy (NAT). Our aim was to analyze factors and outcomes associated with the therapeutic sequence of TKI therapy before and/or after surgery for gastric GISTs. MethodsWe performed a retrospective study of patients surgically treated for a gastric GIST utilizing the 2006–2018 National Cancer Database. We examined demographic, clinical, and pathological characteristics associated with NAT versus adjuvant therapy (AT) using logistic regression. ResultsOf the 3732 patients, 20.4% received NAT and 79.6% had AT. Among patients receiving therapy, NAT significantly increased over our study period (12% to 30.7%). A majority of the AT group received a partial gastrectomy (77.9%) compared with the NAT group who received more near-total/total gastrectomy or gastrectomy with en bloc resection (p < 0.001). In a multivariable model, patients were more likely to receive NAT when insured (private, aOR: 2.37, 95% CI: 1.31–4.29), treated at an academic/research program (aOR: 1.83, 95% CI: 1.49–2.56), had tumors located in the proximal stomach (aOR: 1.40, 95% CI: 1.06–1.86), tumor size > 10 cm (aOR: 1.88, 95% CI: 1.41–2.51), and received near-total/total gastrectomy (aOR: 1.81, 95% CI: 1.42–2.29). There were no differences in outcomes. ConclusionNAT for gastric GIST has increased in utilization. NAT was used in patients with larger tumors and who underwent more extensive resection. Despite these factors, outcomes were similar to patients receiving only AT. More studies are required to determine the therapeutic sequence for gastric GISTs.

“Dovetail” gastric resection: a novel model in the treatment of gastrointestinal stromal tumors

Gastrointestinal stromal tumors (GISTs) are the most common malignant subepithelial lesions of the gastrointestinal tract. The prognosis of this disease is associated with the tumor size and mitotic index. The standard treatment of a GIST without metastasis is surgical resection. The stomach is the most frequent site of the disease and many technical solutions have recently been proposed as shown also by the dramatic increase in publications on this field. There are many studies that suggest laparoscopy may be an acceptable surgical treatment option compared to open surgery for gastric GIST. However, open surgery assumes great importance in large tumors located in difficult to access locations. Here, we present a case involving a 60-year-old man who was diagnosed with gastric antrum GIST, according to a preoperative examination and postoperative pathology. Then, the patient successfully underwent an atypical gastric resection. We proposed a novel surgical technique to be considered in case of gastric benign disease or GIST localized at the gastric antrum.

Comparative study of laparoscopic and open surgery for gastric gastrointestinal stromal tumors

To investigate the feasibility and short-term efficacy of laparoscopic resection of primary localized gastric gastrointestinal stromal tumors (GIST) by comparing with open surgery. Clinicopathological data of 167 gastric GIST patients undergoing operation in Zhongshan Hospital from June 2008 to December 2013 were retrospectively analyzed, among whom 55 received laparoscopic surgery and 112 underwent open surgery for primary local gastric GIST. Efficacy of different size and different location of GIST was compared between laparoscopic and open groups. There was no conversion to open surgery in laparoscopy group. Compared with open surgery, laparoscopic resection for gastric GIST smaller than 5 cm or located at anterior wall, greater curvature, lesser curvature, was associated with similar operation time(P>0.05), but less blood loss, shorter post-hospital stay or flatus time(all P<0.05). The operative outcomes were similar between laparoscopic and open resection for gastric GIST bigger than or equal to 5 cm or located at posterior wall(all P>0.05), except the longer operation time in laparoscopy group(P<0.05). The incidence of postoperative complication did not differ between two groups. Laparoscopic group had 2 patients with gastroparesis and open group had 2 gastroparesis, 2 pulmonary infection, and 1 poor wound healing(all P>0.05), which all recovered after conservative treatment. During 7 to 84 months(median 35) of follow-up, no recurrence or hepatic metastasis was found in laparoscopy group, and 3 hepatic metastases in open group. There was no significant difference of recurrence-free survival between two groups(P>0.05). Laparoscopic resection for gastric GIST is safe and effective in selected patients, especially for those with tumors smaller than 5 cm, or located at anterior wall, greater curvature, lesser curvature, whose short-term outcomes are better than open resection.

Laparoscopic versus open gastric resection for larger than 5 cm primary gastric gastrointestinal stromal tumors (GIST): a size-matched comparison

Laparoscopic resection of gastric gastrointestinal stromal tumors (GISTs) appears technically feasible and associated with favorable outcomes. Tumor size plays an important role in surgical approach, with laparotomy tending to be used to treat larger tumors. This study evaluated the technical feasibility, safety, and oncologic efficacy of laparoscopic surgery for GISTs ≥5cm in diameter. One hundred forty patients who underwent resection of primary gastric GIST at our institution from January 2007 to December 2012 were identified. Twenty-three patients with tumor larger than 5cm in diameter treated by laparoscopic resection and were randomly matched (1:1) by tumor size (±1cm) to patients with open resection. Clinical and pathologic variables and surgical outcomes for each surgical type were identified and compared. There were no significant differences in clinicopathologic characteristics between the two groups. Laparoscopic group was superior to open group in operation time, blood loss, time to ground activities, time to first flatus, times to liquid diet, and postoperative stay (P<0.05). Number of transfusions and time to semi-liquid diet, however, did not differ between groups. There was no operative mortality, and the postoperative complications were similar. Fifteen patients in the laparoscopic group and 17 patients in the open group received adjuvant treatment with imatinib. Recurrence or metastasis occurred in eight cases (three in the laparoscopic group and five in the open group). No significant difference in long-term disease-free survival was found between the two groups (P>0.05). When performed by experienced surgeons, laparoscopic resection for gastric GISTs larger than 5cm is a safe and effective minimally invasive surgery.

Clinical analysis of laparoscopic and endoscopic cooperative surgery in the treatment of gastric gastrointestinal stromal tumor: report of 46 cases

To evaluate the feasibility and safety of laparoscopic and endoscopic cooperative surgery for treating gastric gastrointestinal stromal tumors(GIST). Retrospective analysis was performed on the clinical data of 46 patients with gastric GIST undergoing laparoscopic and endoscopic cooperative surgery between June 2009 and June 2011 at the Renji Hospital of Shanghai Jiaotong University School of Medicine. There were 27 males and 19 females with the mean age of 58.5 years. Thirty-three patients received endoscopy-assisted wedge resection, and 13 cases received laparoscopy-assisted endoscopic resection. All the operations were successful. The mean operative time was (85.5±29.3) min, the mean blood loss was (31.4±12.2) ml, the mean post-operative gastrointestinal functional recovery time was (31.6±14.9) h, and the mean post-operative hospital stay was (5.1±2.9) d. No post-operative complication occurred. NIH risk assessment showed that 34 cases were very low risk and 12 low risk. No recurrence or metastasis was found during the follow-up ranging from 2 to 26 months(median, 12.6 months). Laparoscopic and endoscopic cooperative surgery for gastric GIST is both feasible and safe with minimal invasiveness, fast recovery and satisfactory short-term outcomes.