Laparoscopic versus open gastric resections for primary gastrointestinal stromal tumors (GISTs): a size-matched comparison.
Laparoscopic versus open gastric resections for primary gastrointestinal stromal tumors (GISTs): a size-matched comparison.
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DOI：
10.1245/s10434-010-1517-y
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发表时间：
2011-06
影响因子：
3.7
通讯作者：
Strong VE
中科院分区：
文献类型：
--
作者：
Karakousis GC;Singer S;Zheng J;Gonen M;Coit D;DeMatteo RP;Strong VE
腹腔镜切除胃GIST在技术上似乎是可行的，并与良好的结果相关。然而，肿瘤大小经常在外科手术中起作用，较大的肿瘤倾向于开腹手术，这引起了人们的担忧，即报道的腹腔镜手术的良好结果可能反映了这种选择偏向。从前瞻性收集的肉瘤数据库中，确定了155例原发胃肠道间质瘤切除术(1998年至2009年)；40例非GE交界区胃间质瘤患者接受了成功的腹腔镜切除，并按肿瘤大小(+/−2.0 cm)与开腹手术患者随机匹配(1：1)。通过条件Logistic回归分析，临床、病理变量和手术结果与手术类型相关。两种手术入路在临床和病理变量上具有可比性。中位手术室(OR)时间相似，尽管腹腔镜组术后中位住院时间低于开腹组(4天比7天，p=0.002)，估计失血量(25毫升比100毫升，p=0.006)。无手术死亡，30d并发症发生率相似。肿瘤学结果也相似，没有阳性的显微镜切缘，每组都有1例复发，中位随访时间为34个月。总共有13例中转，其中5例继发于GE交界处或小弯处的肿瘤。当肿瘤大小匹配时，与开腹切除相比，腹腔镜切除原发胃GIST≤8 cm可在类似OR时间的情况下缩短住院时间，同时保持良好的肿瘤学结果。
Laparoscopic resection of gastric GISTs appears technically feasible and associated with favorable outcomes. Tumor size however frequently plays a role in surgical approach with larger tumors tending towards laparotomy, raising concern that favorable outcomes reported for the laparoscopic approach may reflect this selection bias. From a prospectively collected sarcoma database, 155 primary gastric GIST resections were identified (1998–2009); 40 patients underwent successful laparoscopic resection for non-GE junction GIST and were randomly matched (1:1) by tumor size (+/− 2.0 cm) to patients with open resection. Clinical, pathologic variables and surgical outcomes were associated with surgery type using conditional logistic regression analyses. The two surgical approaches were comparable for clinical and pathologic variables. Median operating room (OR) time was similar, although median length of stay post-surgery was lower in the laparoscopic versus open group (4 vs. 7 d, p=0.002), as was estimated blood loss (EBL) (25 vs. 100 mL, p=0.006). There was no operative mortality, and 30 d morbidity was similar. Oncologic outcomes were also similar with no positive microscopic margins, and 1 recurrence in each group with a median follow-up of 34 months. There were 13 conversions overall, 5 secondary to tumor location at the GE junction or lesser curve. When matched for tumor size, laparoscopic resection of primary gastric GISTs ≤ 8 cm results in shorter hospital stays with similar OR time while maintaining sound oncologic outcomes compared to open resection.