J Gastric Cancer.  2012 Dec;12(4):243-248.

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

• Ihn K
• Hyung WJ
• Kim HI
• An JY
• Kim JW
• Cheong JH
• Yoon DS
• Choi SH
• Noh SH

Abstract

PURPOSE
To 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 METHODS
From November 1993 to January 2011, 41 laparoscopic resections were performed among the 95 patients who underwent resection of small intestine < or =10 cm in diameter. The clinicopathologic features, perioperative outcomes, recurrences and survival of these patients were reviewed.
RESULTS
The 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.
CONCLUSIONS
Laparoscopic 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.

Keyword

Gastrointestinal stromal tumors; Laparoscopy; Intestine, small

MeSH Terms

Gastrointestinal Stromal Tumors
Humans
Intestine, Small
Laparoscopy
Length of Stay
Operative Time
Recurrence

Figure

• 

  Fig. 1 Venn diagram depicting recurrence patterns, with number (percent) of patients with each category of recurrence pattern. OPEN = open surgery; LAP = laparoscopic surgery.

• 

  Fig. 2 Kaplan-Meier analysis of (A) overall survival under 10 cm in tumor size, (B) below 5 cm and (C) over 5 cm. OPEN = open surgery; LAP = laparoscopic surgery.

• 

  Fig. 3 Kaplan-Meier analysis of (A) recurrence-free survival under 10 cm in tumor size, (B) below 5 cm and (C) over 5 cm. OPEN = open surgery; LAP = laparoscopic surgery.

Reference

1. Lewis JJ, Brennan MF. Soft tissue sarcomas. Curr Probl Surg. 1996. 33:817–872.

2. Hirota S, Isozaki K, Moriyama Y, Hashimoto K, Nishida T, Ishiguro S, et al. Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Science. 1998. 279:577–580.

3. Miettinen M, Lasota J. Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol. 2006. 23:70–83.

4. Pandey R, Kochar R. Management of gastrointestinal stromal tumors: looking beyond the knife. An update on the role of adjuvant and neoadjuvant imatinib therapy. J Gastrointest Cancer. 2012. [Epub ahead of print].

5. Wu TJ, Lee LY, Yeh CN, Wu PY, Chao TC, Hwang TL, et al. Surgical treatment and prognostic analysis for gastrointestinal stromal tumors (GISTs) of the small intestine: before the era of imatinib mesylate. BMC Gastroenterol. 2006. 6:29.

6. Kim YM, Lim JS, Kim JH, Hyung WJ, Noh SH. Image-based approach for surgical resection of gastric submucosal tumors. J Gastric Cancer. 2010. 10:188–195.

7. Miettinen M, Makhlouf H, Sobin LH, Lasota J. Gastrointestinal stromal tumors of the jejunum and ileum: a clinicopathologic, immunohistochemical, and molecular genetic study of 906 cases before imatinib with long-term follow-up. Am J Surg Pathol. 2006. 30:477–489.

8. Crosby JA, Catton CN, Davis A, Couture J, O'Sullivan B, Kandel R, et al. Malignant gastrointestinal stromal tumors of the small intestine: a review of 50 cases from a prospective database. Ann Surg Oncol. 2001. 8:50–59.

9. Amin AT, Kono Y, Shiraishi N, Yasuda K, Inomata M, Kitano S. Long-term outcomes of laparoscopic wedge resection for gastrointestinal stromal tumors of the stomach of less than 5 cm in diameter. Surg Laparosc Endosc Percutan Tech. 2011. 21:260–263.

10. Catena F, Di Battista M, Fusaroli P, Ansaloni L, Di Scioscio V, Santini D, et al. Laparoscopic treatment of gastric GIST: report of 21 cases and literature's review. J Gastrointest Surg. 2008. 12:561–568.

11. Karakousis GC, Singer S, Zheng J, Gonen M, Coit D, DeMatteo RP, et al. Laparoscopic versus open gastric resections for primary gastrointestinal stromal tumors (GISTs): a size-matched comparison. Ann Surg Oncol. 2011. 18:1599–1605.

12. Sexton JA, Pierce RA, Halpin VJ, Eagon JC, Hawkins WG, Linehan DC, et al. Laparoscopic gastric resection for gastrointestinal stromal tumors. Surg Endosc. 2008. 22:2583–2587.

13. Novitsky YW, Kercher KW, Sing RF, Heniford BT. Long-term outcomes of laparoscopic resection of gastric gastrointestinal stromal tumors. Ann Surg. 2006. 243:738–745.

14. Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, et al. Diagnosis of gastrointestinal stromal tumors: A consensus approach. Hum Pathol. 2002. 33:459–465.

15. Demetri GD, von Mehren M, Antonescu CR, DeMatteo RP, Ganjoo KN, Maki RG, et al. NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Canc Netw. 2010. 8:Suppl 2. S1–S41.

16. Cai W, Wang ZT, Wu L, Zhong J, Zheng MH. Laparoscopically assisted resections of small bowel stromal tumors are safe and effective. J Dig Dis. 2011. 12:443–447.

17. Emory TS, Sobin LH, Lukes L, Lee DH, O'Leary TJ. Prognosis of gastrointestinal smooth-muscle (stromal) tumors: dependence on anatomic site. Am J Surg Pathol. 1999. 23:82–87.

18. Dematteo RP, Gold JS, Saran L, Gönen M, Liau KH, Maki RG, et al. Tumor mitotic rate, size, and location independently predict recurrence after resection of primary gastrointestinal stromal tumor (GIST). Cancer. 2008. 112:608–615.