Skip to main content

Advertisement

SpringerLink
Log in

Is minimally invasive surgery for large gastric GIST actually safe? A comparative analysis of short- and long-term outcomes

  • 2021 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Introduction

While minimally invasive surgery (MIS) is frequently utilized to remove small gastric gastrointestinal stromal tumors (GIST), MIS surgery for tumors ≥ 5 cm is currently not endorsed by national guidelines as standard of care due to concerns of safety and inferior oncologic outcomes. Hence this study investigates the perioperative and long-term outcomes of MIS for T3 gastric GIST measuring 5–10 cm.

Methods

The National Cancer Database (NCDB) 2017 was queried for gastric GIST measuring 5–10 cm or T3 category. Inclusion criteria were known: stage, size, comorbidities, grade, lymphovascular invasion, type of surgery, approach, conversion info, margin status, mitotic rate, neoadjuvant and adjuvant treatment, hospital stay, readmission, 30- and 90-day mortality, complete follow-up, type of institution, and hospital gastric surgery case volume. Binary logistic regression, linear regression models, and Kaplan–Meier survival analysis were used.

Results

In 3765 patients, mean tumor size was 67.3 mm; 26.3% MIS; and 73.8% open. Median hospital stay was shorter for MIS (4.77 vs 7.04 days, p < 0.001). There was no significant difference in incidence of R1 margins [2.9% MIS vs. 3.1% open (p = 0.143)], unplanned readmission [2.9% MIS and 4.1% open (OR 0.474 p = 0.025)], 30-day mortality [0.5% MIS vs 1.2% open (OR 0.325, p = 0.031)], and 90-day mortality [0.9% MIS vs 2.1% open (OR 0.478 p = 0.036)]. Cox regression models for OS showed no difference in survival (p = 0.137, HR 0.808).

Conclusion

This analysis provides substantial evidence that MIS for gastric GIST ≥ 5–10 cm may not only offer improved postoperative morbidity but also oncologic safety. Moreover, as both approaches lead to similar long-term survival, national guidelines may need to incorporate this new information.

Graphical abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Demetri GD, Benjamin RS, Blanke CD, Blay J-Y, Casali P, Choi H, Corless CL, Debiec-Rychter M, DeMatteo RP, Ettinger DS (2007) NCCN Task Force report: management of patients with gastrointestinal stromal tumor (GIST)—update of the NCCN clinical practice guidelines. Journal of the National Comprehensive Cancer Network 5:S-1-S-29

    Article  Google Scholar 

  2. Group ESESNW (2014) Gastrointestinal stromal tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 25 Suppl 3:iii21–26

  3. Demetri GD, Benjamin RS, Blanke CD, Blay JY, Casali P, Choi H, Corless CL, Debiec-Rychter M, DeMatteo RP, Ettinger DS, Fisher GA, Fletcher CD, Gronchi A, Hohenberger P, Hughes M, Joensuu H, Judson I, Le Cesne A, Maki RG, Morse M, Pappo AS, Pisters PW, Raut CP, Reichardt P, Tyler DS, Van den Abbeele AD, von Mehren M, Wayne JD, Zalcberg J, Force NT (2007) NCCN Task Force report: management of patients with gastrointestinal stromal tumor (GIST)--update of the NCCN clinical practice guidelines. J Natl Compr Canc Netw 5 Suppl 2:S1–29; quiz S30

  4. Sasaki A, Koeda K, Obuchi T, Nakajima J, Nishizuka S, Terashima M, Wakabayashi G (2010) Tailored laparoscopic resection for suspected gastric gastrointestinal stromal tumors. Surgery 147:516–520

    Article  Google Scholar 

  5. Ye X, Kang WM, Yu JC, Ma ZQ, Xue ZG (2017) Comparison of short- and long-term outcomes of laparoscopic vs open resection for gastric gastrointestinal stromal tumors. World J Gastroenterol 23:4595–4603

    Article  Google Scholar 

  6. Xu C, Chen T, Hu Y, Balde AI, Liu H, Yu J, Zhen L, Li G (2017) Retrospective study of laparoscopic versus open gastric resection for gastric gastrointestinal stromal tumors based on the propensity score matching method. Surg Endosc 31:374–381

    Article  Google Scholar 

  7. Casali PG, Abecassis N, Aro HT, Bauer S, Biagini R, Bielack S, Bonvalot S, Boukovinas I, Bovee J, Brodowicz T, Broto JM, Buonadonna A, De Alava E, Dei Tos AP, Del Muro XG, Dileo P, Eriksson M, Fedenko A, Ferraresi V, Ferrari A, Ferrari S, Frezza AM, Gasperoni S, Gelderblom H, Gil T, Grignani G, Gronchi A, Haas RL, Hassan B, Hohenberger P, Issels R, Joensuu H, Jones RL, Judson I, Jutte P, Kaal S, Kasper B, Kopeckova K, Krakorova DA, Le Cesne A, Lugowska I, Merimsky O, Montemurro M, Pantaleo MA, Piana R, Picci P, Piperno-Neumann S, Pousa AL, Reichardt P, Robinson MH, Rutkowski P, Safwat AA, Schoffski P, Sleijfer S, Stacchiotti S, Sundby Hall K, Unk M, Van Coevorden F, van der Graaf WTA, Whelan J, Wardelmann E, Zaikova O, Blay JY, Committee EG, Euracan (2018) Gastrointestinal stromal tumours: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 29:iv68-iv78

  8. Novitsky YW, Kercher KW, Sing RF, Heniford BT (2006) Long-term outcomes of laparoscopic resection of gastric gastrointestinal stromal tumors. Ann Surg 243:738

    Article  Google Scholar 

  9. Koh Y-X, Chok A-Y, Zheng H-L, Tan C-S, Chow PK, Wong W-K, Goh BK (2013) A systematic review and meta-analysis comparing laparoscopic versus open gastric resections for gastrointestinal stromal tumors of the stomach. Ann Surg Oncol 20:3549–3560

    Article  Google Scholar 

  10. Di Vita M, Zanghì A, Cavallaro A, Cardì F, Uhlig M, Ursi P, Lo Menzo E, Panebianco V, Cappellani A (2019) Gastric GIST and prognostic models. Which is the best to predict survival after surgery. Ann Ital Chir 90:31–40

    PubMed  Google Scholar 

  11. Hsiao C-Y, Yang C-Y, Lai I-R, Chen C-N, Lin M-T (2015) Laparoscopic resection for large gastric gastrointestinal stromal tumor (GIST): intermediate follow-up results. Surg Endosc 29:868–873

    Article  Google Scholar 

  12. Khoo CY, Goh BKP, Eng AKH, Chan WH, Teo MCC, Chung AYF, Ong HS, Wong WK (2017) Laparoscopic wedge resection for suspected large (>/=5 cm) gastric gastrointestinal stromal tumors. Surg Endosc 31:2271–2279

    Article  Google Scholar 

  13. Lian X, Feng F, Guo M, Cai L, Liu Z, Liu S, Xiao S, Zheng G, Xu G, Zhang H (2017) Meta-analysis comparing laparoscopic versus open resection for gastric gastrointestinal stromal tumors larger than 5 cm. BMC Cancer 17:760

    Article  Google Scholar 

  14. Lin J, Huang C, Zheng C, Li P, Xie J, Wang J, Lu J (2014) Laparoscopic versus open gastric resection for larger than 5 cm primary gastric gastrointestinal stromal tumors (GIST): a size-matched comparison. Surg Endosc 28:2577–2583

    Article  Google Scholar 

  15. Yu M, Wang DC, Wei J, Lei YH, Fu ZJ, Yang YH (2021) Meta-analysis on the efficacy and safety of laparoscopic surgery for large gastric gastrointestinal stromal tumors. Am Surg 87:450–457

    Article  Google Scholar 

  16. Sanchez-Hidalgo JM, Duran-Martinez M, Molero-Payan R, Rufian-Pena S, Arjona-Sanchez A, Casado-Adam A, Cosano-Alvarez A, Briceno-Delgado J (2018) Gastrointestinal stromal tumors: a multidisciplinary challenge. World J Gastroenterol 24:1925–1941

    Article  CAS  Google Scholar 

  17. Dematteo RP, Gold JS, Saran L, Gonen M, Liau KH, Maki RG, Singer S, Besmer P, Brennan MF, Antonescu CR (2008) Tumor mitotic rate, size, and location independently predict recurrence after resection of primary gastrointestinal stromal tumor (GIST). Cancer 112:608–615

    Article  Google Scholar 

  18. Dematteo RP, Ballman KV, Antonescu CR, Maki RG, Pisters PW, Demetri GD, Blackstein ME, Blanke CD, von Mehren M, Brennan MF, Patel S, McCarter MD, Polikoff JA, Tan BR, Owzar K, American College of Surgeons Oncology Group Intergroup Adjuvant GST (2009) Adjuvant imatinib mesylate after resection of localised, primary gastrointestinal stromal tumour: a randomised, double-blind, placebo-controlled trial. Lancet 373:1097–1104

    Article  CAS  Google Scholar 

  19. Casali PG, Le Cesne A, Poveda Velasco A, Kotasek D, Rutkowski P, Hohenberger P, Fumagalli E, Judson IR, Italiano A, Gelderblom H, Adenis A, Hartmann JT, Duffaud F, Goldstein D, Broto JM, Gronchi A, Dei Tos AP, Marreaud S, van der Graaf WT, Zalcberg JR, Litiere S, Blay JY (2015) Time to definitive failure to the first tyrosine kinase inhibitor in localized GI stromal tumors treated with imatinib as an adjuvant: a European Organisation for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group Intergroup Randomized Trial in Collaboration With the Australasian Gastro-Intestinal trials group, UNICANCER, French Sarcoma Group, Italian Sarcoma Group, and Spanish Group for Research on Sarcomas. J Clin Oncol 33:4276–4283

    Article  CAS  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Author notes

  1. Andrew B. Crocker and Eduardo A. Vega have contributed equally to this study.

Authors and Affiliations

  1. Department of Surgery, St. Elizabeth’s Medical Center, Tufts University School of Medicine, 11 Nevins St., Suite 201, Brighton, MA, 02135, USA

    Andrew B. Crocker, Eduardo A. Vega, Omid Salehi, Sebastian Mellado & Claudius Conrad

  2. Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA

    Onur C. Kutlu

  3. Department of Medical Oncology, Dana-Farber Cancer Institute at St. Elizabeth’s Medical Center, Harvard School of Medicine, Boston, MA, USA

    Mu Li & Olga Kozyreva

Authors
  1. Andrew B. Crocker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eduardo A. Vega
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Onur C. Kutlu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Omid Salehi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sebastian Mellado
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mu Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Olga Kozyreva
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Claudius Conrad
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Claudius Conrad.

Ethics declarations

Conflict of interest

Claudius Conrad is a consultant for Fuji, Integra, Immunitas, Stryker, and Olympus. Omid Salehi, Eduardo A. Vega, Onur C. Kutlu, Andrew B. Crocker, Sebastian Mellado, Mu Li, and Olga Kozyreva have no conflicts of interest to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 15 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Crocker, A.B., Vega, E.A., Kutlu, O.C. et al. Is minimally invasive surgery for large gastric GIST actually safe? A comparative analysis of short- and long-term outcomes. Surg Endosc 36, 6975–6983 (2022). https://doi.org/10.1007/s00464-022-09066-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-022-09066-4

Keywords

Search

Navigation