Open versus minimally invasive resection of gastric gist: A multi-institutional analysis of short- and long-term outcomes

Danielle A. Bischof, Yuhree Kim, Rebecca Dodson, M. Carolina Jimenez, Ramy Behman, Andrei Cocieru, Dan G. Blazer, Sarah B. Fisher, Malcolm H. Squires, David A. Kooby, Shishir K. Maithel, Ryan T. Groeschl, T. Clark Gamblin, Todd W. Bauer, Paul J. Karanicolas, Calvin Law, Fayez A. Quereshy, Timothy M. Pawlik

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Abstract

Background. Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. Overall surgical experience with minimally invasive surgery (MIS) has increased; however, published reports on MIS resection of GIST are limited to small, single-institution experiences. Methods. A total of 397 patients who underwent open surgery (n = 230) or MIS (n = 167) for a gastric GIST between 1998 and 2012 were identified from a multicenter database. The impact of MIS approach on recurrence and survival was analyzed using propensity-score matching by comparing clinicopathologic factors between patients who underwent MIS versus open resection. Results. There were 19 conversions (10 %) to open; the most common reasons for conversion were tumor more extensive than anticipated (26 %) and unclear anatomy (21 %). On multivariate analysis, smaller tumor size and higher body mass index (BMI) were associated with receipt of MIS. In the propensity-matched cohort (n = 248), MIS resection was associated with decreased length of stay (MIS, 3 days vs open, 8 days) and fewer ≥ grade 3 complications (MIS, 3 % vs open, 14 %) compared with open surgery. High rates of R0 resection and low rates of tumor rupture were seen in both groups. After propensity-score matching, there was no difference in recurrence-free or overall survival comparing the MIS and the open group (both p > 0.05). Conclusions. An MIS approach for gastric GIST was associated with low morbidity and a high rate of R0 resection. The long-term oncological outcome following MIS was excellent, and therefore the MIS approach should be considered the preferred approach for gastric GIST in well-selected patients.

Original languageEnglish (US)
Pages (from-to)2941-2948
Number of pages8
JournalAnnals of Surgical Oncology
Volume21
Issue number9
DOIs
StatePublished - 2014

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ASJC Scopus subject areas

  • Surgery
  • Oncology
  • Medicine(all)

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Bischof, D. A., Kim, Y., Dodson, R., Carolina Jimenez, M., Behman, R., Cocieru, A., Blazer, D. G., Fisher, S. B., Squires, M. H., Kooby, D. A., Maithel, S. K., Groeschl, R. T., Clark Gamblin, T., Bauer, T. W., Karanicolas, P. J., Law, C., Quereshy, F. A., & Pawlik, T. M. (2014). Open versus minimally invasive resection of gastric gist: A multi-institutional analysis of short- and long-term outcomes. Annals of Surgical Oncology, 21(9), 2941-2948. https://doi.org/10.1245/s10434-014-3733-3