Laparoscopic versus open resection of gastrointestinal stromal tumors of the stomach
Laparoscopic versus open resection of gastrointestinal stromal tumors of the stomach
复制标题
DOI：
10.1007/s00464-012-2622-8
复制
发表时间：
2013-05-01
影响因子：
3.1
通讯作者：
Delvaux, Georges
中科院分区：
文献类型：
--
作者：
De Vogelaere, Kristel;Hoorens, Anne;Delvaux, Georges
胃肠道间质瘤（gist）是最常见的胃肠道间质肿瘤。手术治疗是治愈原发性局部GIST患者的唯一机会。腹腔镜方法被认为是合理的这些肿瘤的胃起源。目前的研究比较了腹腔镜与开放式胃间质瘤切除术的结果，并将我们的研究与少数已发表的开放式与腹腔镜方法比较的研究进行了比较。从前瞻性收集的数据库中，我们发现了53例在我科进行的原发性胃间质瘤切除术。腹腔镜（LAP）切除术37例，传统（OPEN）切除术16例。根据手术方式分析临床病理特点及手术效果。接受LAP或OPEN胃胃肠道间质瘤切除术的患者在手术年龄、性别、临床表现和肿瘤大小方面没有差异。LAP的手术时间明显低于OPEN，平均时间分别为45分钟和132.5分钟（p < 0.001）。LAP切除术显著缩短了患者的住院时间（中位7天vs. 14天，p = 0.007），降低了30天的发病率（2.7% vs. 18.9%, p = 0.077）。OPEN术后手术死亡率为12.5%，LAP术后无手术死亡率（p = 0.087）。LAP术后复发率明显降低（0 % vs. 37.5%; p < 0.001）。LAP组所有患者均存活且无复发，OPEN组25%（4/16）患者存活且复发，但在甲磺酸伊马替尼治疗下完全缓解。开放组2例因GIST进展死亡（p = 0.087）。腹腔镜下胃间质瘤切除术与开放切除术相比，手术时间短，住院时间短，复发率低。
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Surgical treatment is the only chance of cure for patients with a primary localized GIST. A laparoscopic approach has been considered reasonable for these tumors of gastric origin. The current study compares the outcome of laparoscopic versus open resection of gastric GISTs and compares our series with the few published studies comparing the open versus the laparoscopic approach.From a prospectively collected database, we found 53 primary gastric GIST resections that were performed in our department. Laparoscopic (LAP) resections were performed in 37 patients and traditional (OPEN) resections in 16 patients. Clinical and pathologic characteristics and surgical outcomes were analyzed according to surgical procedure.Patients who underwent LAP or OPEN resection of gastric GISTs did not differ with respect to age at operation, gender, clinical presentation, and tumor size. Operative time was significantly lower for LAP than for OPEN resection, with a mean duration of 45 and 132.5 min, respectively (p < 0.001). LAP resection yielded a significantly shorter length of stay (median 7 vs. 14 days; p = 0.007) and lower 30-day morbidity rate (2.7 % vs. 18.9 %; p = 0.077). The operative mortality was 12.5 % after OPEN resection and there was no operative mortality after LAP (p = 0.087). The recurrence rate was significantly lower after LAP surgery (0 % vs. 37.5 %; p < 0.001). All patients in the LAP group are alive without recurrence, and 25 % (4/16) of the OPEN group are alive with recurrence but in complete remission under imatinib mesylate treatment. Two patients of the open group died due to progression of GIST (p = 0.087).Compared to open resection, laparoscopic resection of gastric stromal tumors is associated with a shorter operation time, a shorter hospital stay, and a lower recurrence rate.