TY - JOUR
T1 - Open versus minimally invasive resection of gastric gist
T2 - A multi-institutional analysis of short- and long-term outcomes
AU - Bischof, Danielle A.
AU - Kim, Yuhree
AU - Dodson, Rebecca
AU - Carolina Jimenez, M.
AU - Behman, Ramy
AU - Cocieru, Andrei
AU - Blazer, Dan G.
AU - Fisher, Sarah B.
AU - Squires, Malcolm H.
AU - Kooby, David A.
AU - Maithel, Shishir K.
AU - Groeschl, Ryan T.
AU - Clark Gamblin, T.
AU - Bauer, Todd W.
AU - Karanicolas, Paul J.
AU - Law, Calvin
AU - Quereshy, Fayez A.
AU - Pawlik, Timothy M.
PY - 2014
Y1 - 2014
N2 - 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.
AB - 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.
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U2 - 10.1245/s10434-014-3733-3
DO - 10.1245/s10434-014-3733-3
M3 - Article
C2 - 24763984
AN - SCOPUS:84906248431
SN - 1068-9265
VL - 21
SP - 2941
EP - 2948
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 9
ER -