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Schena CA, Luzzi AP, Laterza V, De Simone B, Aisoni F, Gavriilidis P, Catena F, Coccolini F, Morciano F, Rosa F, Marchegiani F, de'Angelis N. Gastrointestinal Stromal Tumors of the Stomach: Is There Any Advantage of Robotic Resections? A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2024. [PMID: 38962886 DOI: 10.1089/lap.2024.0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024] Open
Abstract
Background: The role of robotic surgery for gastrointestinal stromal tumor (GIST) resection remains unclear. This systematic review and meta-analysis aimed to investigate the outcomes of robotic versus laparoscopic surgery in patients requiring surgery for gastric GISTs. Methods: MEDLINE, EMBASE, and the Cochrane databases were searched from inception to September 4, 2023. Two independent reviewers conducted a systematic review of the literature to select all types of analytic studies comparing robotic versus laparoscopic surgery for GISTs and reporting intraoperative, postoperative, and/or pathological outcomes. Results: Overall, 4 retrospective studies were selected, including a total of 264 patients, specifically 111 (42%) in the robotic and 153 (58%) in the laparoscopic group. Robotic surgery was associated with longer operating time (+42.46 min; 95% confidence interval [CI]: 9.34, 75.58; P=0.01; I2: 85%) and reduced use of mechanical staplers (odds ratio [OR]: 0.05; 95%CI: 0.02, 0.11; P<0.00001; I2: 92%;) compared with laparoscopy. Although nonsignificant, conversion to open surgery was less frequently reported for robotic surgery (2.7%) than laparoscopy (5.2%) (OR: 0.59; 95%CI: 0.17, 2.03; P=0.4; I2: 0%). No difference was found for postoperative and oncological outcomes. Conclusions: Robotic surgery for gastric GISTs provides similar intraoperative, postoperative, and pathological outcomes to laparoscopy, despite longer operative time.
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Affiliation(s)
- Carlo Alberto Schena
- Unit of Robotic and Minimally Invasive Digestive Surgery, Department of Surgery, Ferrara University Hospital Arcispedale Sant'Anna, Ferrara, Italy
| | - Andrea-Pierre Luzzi
- Dipartimento di Medicina Interna e Specialità Mediche (Di.M.I.), Università di Genova, Genoa, Italy
| | - Vito Laterza
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, University Hospital of Besançon, Besançon, France
| | - Belinda De Simone
- Department of Minimally Invasive Surgery, Guastalla Hospital, AUSL-IRCCS Reggio, Emilia, Italy
| | - Filippo Aisoni
- Unit of Emergency Surgery, Department of Surgery, Ferrara University Hospital Arcispedale Sant'Anna, Ferrara, Italy
| | - Paschalis Gavriilidis
- Department of HBP Surgery, University Hospitals Coventry and Warwickshire NHS Trust,, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom
| | - Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Department, Pisa University Hospital, Pisa, Italy
| | - Francesca Morciano
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital (AP-HP), Clichy, France
| | - Fausto Rosa
- Emergency and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Marchegiani
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital (AP-HP), Clichy, France
| | - Nicola de'Angelis
- Unit of Robotic and Minimally Invasive Digestive Surgery, Department of Surgery, Ferrara University Hospital Arcispedale Sant'Anna, Ferrara, Italy
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
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Musa J, Kochendoerfer SM, Willis F, Sauerteig C, Harnoss JM, Rompen IF, Grünewald TGP, Al-Saeedi M, Schneider M, Harnoss JC. The GIST of it all: management of gastrointestinal stromal tumors (GIST) from the first steps to tailored therapy. A bibliometric analysis. Langenbecks Arch Surg 2024; 409:95. [PMID: 38480587 PMCID: PMC10937785 DOI: 10.1007/s00423-024-03271-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/24/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE Improvement of patient care is associated with increasing publication numbers in biomedical research. However, such increasing numbers of publications make it challenging for physicians and scientists to screen and process the literature of their respective fields. In this study, we present a comprehensive bibliometric analysis of the evolution of gastrointestinal stromal tumor (GIST) research, analyzing the current state of the field and identifying key open questions going beyond the recent advantages for future studies to assess. METHODS Using the Web of Science Core Collection, 5040 GIST-associated publications in the years 1984-2022 were identified and analyzed regarding key bibliometric variables using the Bibliometrix R package and VOSviewer software. RESULTS GIST-associated publication numbers substantially increased over time, accentuated from year 2000 onwards, and being characterized by multinational collaborations. The main topic clusters comprise surgical management, tyrosine kinase inhibitor (TKI) development/treatment, diagnostic workup, and molecular pathophysiology. Within all main topic clusters, a significant progress is reflected by the literature over the years. This progress ranges from conventional open surgical techniques over minimally invasive, including robotic and endoscopic, resection techniques to increasing identification of specific functional genetic aberrations sensitizing for newly developed TKIs being extensively investigated in clinical studies and implemented in GIST treatment guidelines. However, especially in locally advanced, recurrent, and metastatic disease stages, surgery-related questions and certain specific questions concerning (further-line) TKI treatment resistance were infrequently addressed. CONCLUSION Increasing GIST-related publication numbers reflect a continuous progress in the major topic clusters of the GIST research field. Especially in advanced disease stages, questions related to the interplay between surgical approaches and TKI treatment sensitivity should be addressed in future studies.
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Affiliation(s)
- Julian Musa
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Department of General, Visceral, Thoracic, and Transplantation Surgery, University Hospital Giessen and Marburg, Giessen, Germany
- Division of Translational Pediatric Sarcoma Research (B410), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Hopp-Children's Cancer Center (KiTZ), Heidelberg, Germany
| | - Sarah M Kochendoerfer
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Franziska Willis
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Department of General, Visceral, Thoracic, and Transplantation Surgery, University Hospital Giessen and Marburg, Giessen, Germany
| | - Christine Sauerteig
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Jonathan M Harnoss
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Department of General, Visceral, Thoracic, and Transplantation Surgery, University Hospital Giessen and Marburg, Giessen, Germany
| | - Ingmar F Rompen
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Thomas G P Grünewald
- Division of Translational Pediatric Sarcoma Research (B410), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Hopp-Children's Cancer Center (KiTZ), Heidelberg, Germany
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Mohammed Al-Saeedi
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Martin Schneider
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Department of General, Visceral, Thoracic, and Transplantation Surgery, University Hospital Giessen and Marburg, Giessen, Germany
| | - Julian-C Harnoss
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
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Harada H, Ohashi M, Hiki N, Fujisaki J, Hirasawa T, Yamamoto Y, Makuuchi R, Ida S, Hayami M, Kumagai K, Sano T, Nunobe S. Excellent oncological outcomes besides short-term safety of laparoscopic and endoscopic cooperative surgery for gastric gastrointestinal stromal tumor. Endosc Int Open 2022; 10:E1254-E1260. [PMID: 36118650 PMCID: PMC9473822 DOI: 10.1055/a-1895-9507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/05/2022] [Indexed: 10/27/2022] Open
Abstract
Background and study aims Laparoscopic and endoscopic cooperative surgery (LECS) for gastric submucosal tumor was developed as a type of minimal local resection and is now widely used in Asian countries. However, the oncological safety of LECS for gastric gastrointestinal stromal tumor (GIST) remains unclear. LECS has potential oncology-related problems that may influence survival outcomes. Furthermore, the feasibility and safety of LECS have not yet been fully established. Patients and methods Patients who were intended to undergo LECS for gastric GIST from 2006 to 2020 were retrospectively selected. The indication for LECS was determined according to the guidelines. The completion of LECS, complications, and survival outcomes of the patients were analyzed. Results Two hundred fifty-nine patients were eligible in this study. According to intraoperative findings, 44 patients underwent local resection without luminal endoscopic procedures. Of the remaining 215 patients, 213 completely underwent LECS, which corresponds to a completion rate of 99.1 %. Six patients (2.8 %) had postoperative complications of Clavien-Dindo classification grade II or higher. Delayed gastric emptying was most commonly found in four patients (1.9 %). Old age ( P = 0.0349), female sex ( P = 0.0095), tumor located in the lesser curvature ( P = 0.0015), and large tumor diameter ( P = 0.0232) were significantly more common in patients with complications. The 3-year overall and disease-specific survival rates were 99 % and 100 %, respectively, in 215 patients who were intended to undergo LECS. Conclusions Despite several oncological concerns, LECS for gastric GIST is oncologically safe besides a feasible and safe procedure in the short-term.
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Affiliation(s)
- Hiroki Harada
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan,Department of Upper-gastrointestinal Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Manabu Ohashi
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Naoki Hiki
- Department of Upper-gastrointestinal Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Junko Fujisaki
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiaki Hirasawa
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yorimasa Yamamoto
- Division of Gastroenterology, Endoscopy Center, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Rie Makuuchi
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Satoshi Ida
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masaru Hayami
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Koshi Kumagai
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takeshi Sano
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Souya Nunobe
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Crocker AB, Vega EA, Kutlu OC, Salehi O, Mellado S, Li M, Kozyreva O, Conrad C. Is minimally invasive surgery for large gastric GIST actually safe? A comparative analysis of short- and long-term outcomes. Surg Endosc 2022; 36:6975-6983. [PMID: 35312847 DOI: 10.1007/s00464-022-09066-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 01/17/2022] [Indexed: 10/18/2022]
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.
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Affiliation(s)
- Andrew B Crocker
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, 11 Nevins St., Suite 201, Brighton, MA, 02135, USA
| | - Eduardo A Vega
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, 11 Nevins St., Suite 201, Brighton, MA, 02135, USA
| | - Onur C Kutlu
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Omid Salehi
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, 11 Nevins St., Suite 201, Brighton, MA, 02135, USA
| | - Sebastian Mellado
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, 11 Nevins St., Suite 201, Brighton, MA, 02135, USA
| | - Mu Li
- Department of Medical Oncology, Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Harvard School of Medicine, Boston, MA, USA
| | - Olga Kozyreva
- Department of Medical Oncology, Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Harvard School of Medicine, Boston, MA, USA
| | - Claudius Conrad
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, 11 Nevins St., Suite 201, Brighton, MA, 02135, USA.
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Jia J, Wang M, Lin G, Gao Z, Liu Q, Zhang P, Xia L, Feng F, Zhao Y, Hu J, Xiong Z, Wan W, Yin Y, Cao H, Zhang B, Tao K. Laparoscopic Versus Open Surgery for Rectal Gastrointestinal Stromal Tumor: A Multicenter Propensity Score-Matched Analysis. Dis Colon Rectum 2022; 65:519-528. [PMID: 34759244 DOI: 10.1097/dcr.0000000000002014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The safety and feasibility of laparoscopic surgery for the management of rectal gastrointestinal stromal tumors are unknown. OBJECTIVE This study aimed to compare the surgical and oncologic results of laparoscopic versus open surgery for the treatment of rectal gastrointestinal stromal tumors. DESIGN This was a retrospective multicenter propensity score-matched study to minimize heterogeneity between groups and focus on the difference between surgery strategies. SETTINGS Eleven Chinese tertiary hospitals participated in this study. PATIENTS A total of 364 patients with pathologically confirmed rectal gastrointestinal stromal tumors were retrospectively analyzed. MAIN OUTCOME MEASURES Relapse-free survival, postoperative hospital stay length, and 30-day postoperative complication rate were the main outcome measures. RESULTS We enrolled 214 patients who underwent surgical operation for primary localized rectal gastrointestinal stromal tumors. After propensity score matching, 134 cases involved in the comparison (67 laparoscopic vs 67 open surgery) were randomly matched (1:1) by sex, age, tumor size, tumor site, and neoadjuvant therapy. The laparoscopic surgery group had superior relapse-free survival (χ2 = 4.46, p = 0.04), and fewer complications (6.0% vs 25.4%, p = 0.002). No significant difference was found in the length of postoperative hospital stay between the laparoscopic surgery and open surgery groups (9.66 ± 5.42 vs. 10.64 ± 4.93, p = 0.28). Subgroup analysis showed that the laparoscopic surgery group had superior relapse-free survival (χ2 = 4.14, p = 0.04) and fewer complications after surgery (2.9% vs 24.4%, p = 0.01) in the rectal gastrointestinal stromal tumors ≤5 cm subgroup. LIMITATIONS This study was limited by the nature of retrospective reviews and relatively short follow-up period. CONCLUSIONS Laparoscopic surgery offers a safe and feasible option for the radical resection of primary localized rectal gastrointestinal stromal tumors, especially for patients with rectal gastrointestinal stromal tumors ≤5 cm. See Video Abstract at http://links.lww.com/DCR/B764. CIRUGA LAPAROSCPICA VERSUS CIRUGA ABIERTA PARA TUMORES DEL ESTROMA GASTROINTESTINAL DE RECTO UN ANLISIS MULTICNTRICO EMPAREJADO POR PUNTAJE DE PROPENSIN ANTECEDENTES:Se desconoce la seguridad y factibilidad de la cirugía laparoscópica para el tratamiento de los tumores del estroma gastrointestinal de recto.OBJETIVO:Comparar los resultados quirúrgicos y oncológicos de la cirugía laparoscópica versus cirugía abierta para el tratamiento de los tumores del estroma gastrointestinal de recto.DISEÑO:Estudio retrospectivo multicéntrico emparejado por puntuación de propensión para minimizar la heterogeneidad entre los grupos y centrarse en las diferencias entre las estrategias quirúrgicas.AJUSTES:Once hospitales terciarios de la China participaron en este estudio.PACIENTES:Se analizaron retrospectivamente un total de 364 pacientes con tumores del estroma gastrointestinal de recto confirmados patológicamente.PRINCIPALES MEDIDAS DE VALORACION:Supervivencia sin recidiva, duración de la estancia hospitalaria postquirúrgica y tasa de complicaciones postquirúrgicas a los 30 días.RESULTADOS:Inscribimos a 214 pacientes que fueron sometidos a cirugía por tumores primariamente localizados del estroma gastrointestinal de recto. Después del emparejamiento por puntaje de propensión, 134 casos involucrados en la comparación (67 laparoscópicos versus 67 cirugía abierta) fueron emparejados aleatoriamente (1: 1) por sexo, edad, tamaño del tumor, sitio del tumor y terapia neoadyuvante. El grupo de cirugía laparoscópica tuvo una supervivencia sin recidiva superior (χ2 = 4,46, p = 0,04) y menos complicaciones (6,0% frente a 25,4%, p = 0,002). No se encontraron diferencias significativas en la duración de la estancia hospitalaria postquirúrgica entre los grupos de cirugía laparoscópica y cirugía abierta (9,66 ± 5,42 frente a 10,64 ± 4,93, p = 0,28). El análisis de subgrupos mostró que el grupo de cirugía laparoscópica tuvo una supervivencia sin recidiva superior (χ2 = 4,14, p = 0,04) y menos complicaciones después de la cirugía (2,9% frente a 24,4%, p = 0,01) en el subgrupo de tumores del estroma gastrointestinal de recto ≤ 5 cm.LIMITACIONES:La naturaleza de la revisión retrospectiva y el período de seguimiento relativamente corto son limitaciones de este estudio.CONCLUSIONES:La cirugía laparoscópica ofrece una opción segura y factible para la resección radical de tumores primariamente localizados del estroma gastrointestinal de recto, especialmente para pacientes con tumores ≤5 cm. Consulte Video Resumen en http://links.lww.com/DCR/B764.
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Affiliation(s)
- Jie Jia
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ming Wang
- Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guole Lin
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhidong Gao
- Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing, China
| | - Qian Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union College, Beijing, China
| | - Peng Zhang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lijian Xia
- Department of General Surgery, the First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Fan Feng
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an, China
| | - Yan Zhao
- Department of Gastric Surgery, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, Shenyang, China
| | - Junbo Hu
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiguo Xiong
- Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenze Wan
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuan Yin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hui Cao
- Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bo Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Kaixiong Tao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Xu Z, Qu H, Ren Y, Gong Z, Kanani G, Zhang F, Shao S, Chen X, Chen X. A propensity score-matched analysis of laparoscopic versus open surgical radical resection for gastric gastrointestinal stromal tumor. J Minim Access Surg 2021; 18:510-518. [PMID: 35046173 DOI: 10.4103/jmas.jmas_199_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Surgery is the mainstay of treatment for gastric gastrointestinal stromal tumours (GIST). However, the choice of surgical approach for gastric GIST remains controversial. AIMS AND OBJECTIVES To evaluate the short- and long-term efficacies of laparoscopic surgery versus conventional open surgery for gastric GIST. MATERIALS AND METHODS We retrospectively reviewed 148 patients with gastric GIST at our hospital between January 2013 and January 2020. The patients were categorised into the following two groups based on the surgery performed: The laparoscopic surgery group (LG) and the open surgery group (OG). Differences in the tumour size, surgical procedures and modified National Institutes of Health classification were statistically significant. To balance the intergroup confounders, we performed 1:1 propensity score matching (PSM). RESULTS A total of 104 patients were selected after PSM (52 in each group). We focused on the short- and long- term outcomes of patients. The baseline information was balanced between the two groups after PSM. The LG benefited from the advantages of a minimally invasive surgery (faster gastrointestinal function recovery, shorter time to drainage tube removal, less blood loss and shorter hospitalisation period), however, it also had high treatment costs. Moreover, both laparoscopic and open surgeries resulted in similar intra-operative and post-operative complications rates, overall survival time and disease-free survival time. CONCLUSION Laparoscopic resection is feasible and oncologically safe for GIST. However, more prospective studies are required to confirm the findings.
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Affiliation(s)
- ZhaoHui Xu
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University; Graduate School of Dalian Medical University, Dalian, China
| | - Hui Qu
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University; Graduate School of Dalian Medical University, Dalian, China
| | - YanYing Ren
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, China
| | - ZeZhong Gong
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University; Graduate School of Dalian Medical University, Dalian, China
| | - George Kanani
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University; Graduate School of Dalian Medical University, Dalian, China
| | - Fan Zhang
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, China
| | - Shuai Shao
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, China
| | - XiaoLiang Chen
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, China
| | - Xin Chen
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, China
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Ceccarelli G, Costa G, De Rosa M, Codacci Pisanelli M, Frezza B, De Prizio M, Bravi I, Scacchi A, Gallo G, Amato B, Bugiantella W, Tacchi P, Bartoli A, Patriti A, Cappuccio M, Komici K, Mariani L, Avella P, Rocca A. Minimally Invasive Approach to Gastric GISTs: Analysis of a Multicenter Robotic and Laparoscopic Experience with Literature Review. Cancers (Basel) 2021; 13:cancers13174351. [PMID: 34503161 PMCID: PMC8431126 DOI: 10.3390/cancers13174351] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/04/2021] [Accepted: 08/24/2021] [Indexed: 01/07/2023] Open
Abstract
Simple Summary Gastrointestinal stromal tumors (GISTs) represent about 1–3% of all gastrointestinal malignancies, of which 50–60% are gastric GISTs (GGs). To the date, surgery represents the best therapeutic option, and the robotic gastric surgery could gain an important role, overcoming many laparoscopic drawbacks. The aim of this study is to evaluate safety and effectiveness of minimally invasive surgery (MIS) for GGs, reporting 10-year experience of three different centers. We included a population of 81 patients who underwent MIS approaches (36 laparoscopy vs. 45 robotic surgery). Seventy-two (72) patients were enrolled in a follow-up program to evaluate the long-term oncological outcomes. Furthermore, we discussed some technical notes and also we analyzed the operative and peri-operative outcomes. In conclusion, our results suggest that the robotic approach might be a suitable treatment, especially for GISTs >5 cm, even located in unfavorable places, despite longer operative time and costs than laparoscopic approach. Abstract Background: Gastrointestinal stromal tumors (GISTs) are most frequently located in the stomach. In the setting of a multidisciplinary approach, surgery represents the best therapeutic option, consisting mainly in a wedge gastric resection. (1) Materials and methods: Between January 2010 to September 2020, 105 patients with a primary gastrointestinal stromal tumor (GISTs) located in the stomach, underwent surgery at three surgical units. (2) Results: A multi-institutional analysis of minimally invasive series including 81 cases (36 laparoscopic and 45 robotic) from 3 referral centers was performed. Males were 35 (43.2%), the average age was 66.64 years old. ASA score ≥3 was 6 (13.3%) in the RS and 4 (11.1%) in the LS and the average tumor size was 4.4 cm. Most of the procedures were wedge resections (N = 76; 93.8%) and the main operative time was 151 min in the RS and 97 min in the LS. Conversion was necessary in five cases (6.2%). (3) Conclusions: Minimal invasive approaches for gastric GISTs performed in selected patients and experienced centers are safe. A robotic approach represents a useful option, especially for GISTs that are more than 5 cm, even located in unfavorable places.
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Affiliation(s)
- Graziano Ceccarelli
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, 06034 Foligno, Italy; (G.C.); (G.C.); (W.B.); (P.T.); (A.B.); (A.P.); (L.M.)
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, ASL 2 Umbria, San Matteo Hospital, 06049 Spoleto, Italy
- General Surgery Unit, San Donato Hospital, 52100 Arezzo, Italy; (B.F.); (M.D.P.)
| | - Gianluca Costa
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, 06034 Foligno, Italy; (G.C.); (G.C.); (W.B.); (P.T.); (A.B.); (A.P.); (L.M.)
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, ASL 2 Umbria, San Matteo Hospital, 06049 Spoleto, Italy
- Surgery Center, University Campus Bio-Medico of Rome, 00128 Rome, Italy
| | - Michele De Rosa
- Department of General Surgery, San Giovanni Battista Hospital, 06034 Perugia, Italy;
| | - Massimo Codacci Pisanelli
- UOC General Surgery and Laparoscopic Surgery, Department of Surgery P. Valdoni, Policlinic Umberto I, Sapienza University of Study of Rome, 00161 Rome, Italy;
| | - Barbara Frezza
- General Surgery Unit, San Donato Hospital, 52100 Arezzo, Italy; (B.F.); (M.D.P.)
| | - Marco De Prizio
- General Surgery Unit, San Donato Hospital, 52100 Arezzo, Italy; (B.F.); (M.D.P.)
| | - Ilaria Bravi
- Histopathology Department, Usl Umbria 2, San Giovanni Battista Hospital, 06034 Foligno, Italy;
| | - Andrea Scacchi
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy; (A.S.); (M.C.); (K.K.); (P.A.)
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, 88100 Catanzaro, Italy;
- Department of Colorectal Surgery, S. Rita Clinic, 13100 Vercelli, Italy
| | - Bruno Amato
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80126 Naples, Italy;
| | - Walter Bugiantella
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, 06034 Foligno, Italy; (G.C.); (G.C.); (W.B.); (P.T.); (A.B.); (A.P.); (L.M.)
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, ASL 2 Umbria, San Matteo Hospital, 06049 Spoleto, Italy
| | - Piergiorgio Tacchi
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, 06034 Foligno, Italy; (G.C.); (G.C.); (W.B.); (P.T.); (A.B.); (A.P.); (L.M.)
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, ASL 2 Umbria, San Matteo Hospital, 06049 Spoleto, Italy
| | - Alberto Bartoli
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, 06034 Foligno, Italy; (G.C.); (G.C.); (W.B.); (P.T.); (A.B.); (A.P.); (L.M.)
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, ASL 2 Umbria, San Matteo Hospital, 06049 Spoleto, Italy
| | - Alberto Patriti
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, 06034 Foligno, Italy; (G.C.); (G.C.); (W.B.); (P.T.); (A.B.); (A.P.); (L.M.)
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, ASL 2 Umbria, San Matteo Hospital, 06049 Spoleto, Italy
- Division of General Surgery, Ospedali Riuniti Marche Nord, 61121 Pesaro, Italy
| | - Micaela Cappuccio
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy; (A.S.); (M.C.); (K.K.); (P.A.)
| | - Klara Komici
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy; (A.S.); (M.C.); (K.K.); (P.A.)
| | - Lorenzo Mariani
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, 06034 Foligno, Italy; (G.C.); (G.C.); (W.B.); (P.T.); (A.B.); (A.P.); (L.M.)
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, ASL 2 Umbria, San Matteo Hospital, 06049 Spoleto, Italy
| | - Pasquale Avella
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy; (A.S.); (M.C.); (K.K.); (P.A.)
| | - Aldo Rocca
- General Surgery Unit, San Donato Hospital, 52100 Arezzo, Italy; (B.F.); (M.D.P.)
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy; (A.S.); (M.C.); (K.K.); (P.A.)
- Correspondence:
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Iordanou C, Theodoridis CA, Lykoudis PM, Dimitroulis D, Machairas N, Spartalis E, Kouki P, Pikoulis E, Nikiteas N. Current evidence on laparoscopic vs. open resection for gastric stromal tumours. Oncol Lett 2021; 22:734. [PMID: 34429774 DOI: 10.3892/ol.2021.12995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/26/2021] [Indexed: 01/29/2023] Open
Abstract
Although the use of laparoscopic surgery is increasing, controversy still surrounds its application for malignant conditions. Gastrointestinal stromal tumours (GISTs) are less demanding in terms of lymphadenectomy, meaning that laparoscopic resection might have a more defined benefit when compared with open resection. To the best of our knowledge, no randomized study exists that compares the laparoscopic and open resection of GISTs. The current study aimed to examine the relevant literature by means of a systematic review. A systematic literature search was performed individually by two authors, in which three independent databases were searched using specific search-terms. Titles, abstracts and full texts were screened, as well as references to relevant articles, in order to comprise a comprehensive list of studies. Data were extracted using a detailed pre-agreed spreadsheet. Studies were evaluated according to the modified MINORS criteria. A total of 10 studies were included in the present review, yielding a total of 14 entries. The majority of studies reported significantly improved perioperative outcomes for the laparoscopic approach, including improved duration of operation, blood loss and length of hospital stay. Only four studies reported long-term outcomes and findings that were controversial, with some studies detecting no statistically significant differences, one reporting improved and one reporting worse disease-free and overall survival for the laparoscopic group. Three studies were deemed to be good quality, two of which had not reported significantly different long-term outcomes, while the third had reported significantly improved outcomes in the open resection group. While there is a clear benefit for performing laparoscopic surgery in patients with GIST with regards to perioperative outcomes, when it comes to long-term oncological outcomes, uncertainty over its application remains. The lack of randomized trials, as well as the poor reporting of retrospective studies, limits the amount of evidence that is currently available. Laparoscopic surgery for GIST is certainly safe, feasible and likely cost-effective; however, further studies are required to inform on whether this technique is superior to open resection.
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Affiliation(s)
- Christos Iordanou
- Department of Hepato-Biliary and Pancreatic Surgery, Metropolitan Hospital, 18547 Piraeus, Greece
| | - Charalampos A Theodoridis
- Third Department of Surgery, 'Attiko' University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Panagis M Lykoudis
- Third Department of Surgery, 'Attiko' University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece.,Division of Surgery and Interventional Science, University College London, WC1E 6BT London, UK
| | - Dimitrios Dimitroulis
- Second Propaedeutic Surgical Department, 'Laiko' Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Nikolaos Machairas
- Second Propaedeutic Surgical Department, 'Laiko' Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Eleftherios Spartalis
- Second Propaedeutic Surgical Department, 'Laiko' Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Pinelopi Kouki
- Department of Anaesthetics, General District Hospital of Nikaia 'Agios Panteleimon', 18454 Nikaia, Greece
| | - Emmanouil Pikoulis
- Third Department of Surgery, 'Attiko' University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Nikolaos Nikiteas
- Second Propaedeutic Surgical Department, 'Laiko' Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
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A gastrointestinal stromal tumor of stomach presenting with an intratumoral abscess: A case report. Ann Med Surg (Lond) 2021; 63:102143. [PMID: 33643648 PMCID: PMC7895705 DOI: 10.1016/j.amsu.2021.01.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the gastrointestinal tract, GISTs of the stomach presenting as an intratumoral abscess are extremely rare, which necessitates emergency surgery, we report a case of a stomach GIST developing an intratumoral abscess, in whom emergency surgery was performed. Presentation of case A 68-year-old man presented with severe abdominal pain and a fever. Laboratory data showed an elevated white blood cell count and C-reactive protein level. Computed to mography scan showed a 15 × 10 cm cystic mass adjacent to greater curvature of the stomach, which contained air. Emergency laparotomy revealed A giant cystic gastric mass was observed. Sleeve gastrectomy were performed. Immunohistochemically, the tumor was diagnosed as a Gastric high risk GIST,and imatinib mesylate was initiated, The patient had an uneventful postoperative course and remains well. Discussion and conclusion Such rare cases can be diagnosed and treated properly with careful clinical evaluation, surgical resection and adjuvant chemotherapy with imatinib mesylate is still the mainstay and most effective treatment for GISTs to date.
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