| Gastrointestinal stromal tumor(GIST)is the most common mesenchymal tumor in the gastrointestinal tract.Complete surgical resection is still the best treatment method to GIST.The application of laparoscopic minimally invasive surgery will be have a better future because of these biological characteristics of gastric GIST.There are no randomized controlled studies for laparoscopy compared with laparotomy for the treatment of GIST.Propensity score method is a tool to adjust a treatment effect for measured confounding factors in non-randomized controlled studies.The logic behind propensity score methods is that balance on observed covariates is achieved through careful matching on a propensity score.Our research aims at assessing the safety,feasibility and the prognosis of laparoscopic resection of gastric stromal tumor by comparing it with open resection base on propensity score matching method.Part Ⅰ The comparative study on laparoscopic surgery and open surgery of gastric GISTObjective:To explore the safety,feasibility and prognostic factors of gastric GIST laparoscopic surgery through the comparative study on laparoscopic surgery and open surgery of gastric GIST.Methods:The clinical and follow-up data of patients with primary gastric GIST in January 2005 to April 2014 was analyzed retrospectively.153 cases underwent laparoscopic surgery were treated as the experimental group,and 58 cases underwent open surgery were treated as control group.Results:The single factor analysis showed that tumor diameter(P = 0.004),tumor location(P = 0.004),the risk classification(P = 0.000),surgical approach(P = 0.024)were relate to the disease-free survival(outcome)or not.Logistic regression analysis showed that the risk classification is a significant independent risk factor for disease-free survival,with an adjusted HR of 10.684.The higher the positive expression rate of the ki-67 index,the higher the mitotic index,the higher the risk classification grade,the larger the tumor diameter.Conclusions:1.Logistic regression analysis showed that the risk classification is a significant independent risk factor for disease-free survival,with an adjusted RR of 10.684.2.The ki-67 index is a supplementary diagnostic index for gastric GIST.It may be an effective indicator to determine the risk classification and prognosis of gastric GIST.3.There were significant differences in baseline data between the two groups in the retrospective study.Part Ⅱ To analyze the advantage of laparoscopic surgery for gastric GIST based on the propensity scoring matching methodObjective:To evaluate the safety and long-term efficacy of laparoscopic surgery for gastric stromal tumors based on the PSM methodMethods:The clinical and follow-up data of patients with primary gastric GIST in January 2005 to April 2014 was collected.PSM method is used to balance of preoperative variables.The probability(propensity score)that the research object was assigned to the two groups was estimated.And then match the individual from two groups of the same or similar score.Results:44 cases were included in the open surgery group,and 44 cases were included in the laparoscope group.The matching efficiency was excellent.After PSM,the operative time,blood loss,time to remove the stomach tube,time to remove the drainage tube,exhaust time,time to liquid,time to semi-liquid,time to move down,the length of stay in laparoscopic group was better than those of the open group.After PSM,survival analysis showed that there was no significant difference between the two groups(χ2=0.211,P = 0.646).Conclusions:1.After the propensity score matching,the intraoperative and postoperative indexes of laparoscopic surgery were significantly better than that of open surgery.2.At a mean follow-up of 42 months,Long-term results of laparoscopic surgery are similar to those of open surgery for gastric GIST.3.The laparoscopic surgery is safe and feasible for the tumor less than 5 cm.This must be further confirmed in randomized controlled trials. |
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