Laparoscopic Versus Open Resection Of Gastic Stromal Tumors

Background:Gastrointestinal stromal tumors (GISTs) represent a rare but distinct histopathologic group of intestinal neoplasms of mesenchymal origin.Historically, most of these tumors were classified as leiomyomas, leiomyoblastomas, or leiomyosarcomas due to the mistaken belief that they were of smooth muscle origin.However, with the advent of electron microscopy and immunohistochemistry, a pleuropotential intestinal pacemaker cell, the interstitial cell of Cajal, was identified as the origin of GISTs.The recent discovery and identification of the CD117 antigen, a c-kit proto-oncogene product, and CD34, a human progenitor cell antigen, in the majority of GISTs have led to further delineation of the cellular characteristics of these neoplasms.Although GISTs are found throughout the gastrointestinal tract, the stomach is the site of occurrence in more than half of patients.Their metastatic potential is difficult to predict due to the lack of clear clinical or pathologic signs of malignancy other than obvious metastasis at surgery. In addition, local recurrence or distant metastasis may not present until years after the initial diagnosis. Surgical resection is required for cure of gastric GISTs.Because extensive resections and lymphadenectomies are usually not required, the laparoscopic approach has been considered reasonable for gastrointestinal stromal tumors(GISTs) of gastric origin.It has been reported with increased frequency.Few comparisons have been done between laparoscopic and open surgery.This study compaired the relative efficacy of the two approaches and assesses the feasibility and efficacy of the laparoscopic approach.Object: To compare the relative efficacy of laparoscopic and open resection of gastric stromal tumors and assess the feasibility and effectiveness of the laparoscopic approach.Methods: We reviewed 61 consecutive patients who underwent laparoscopic or traditional open resection of gastric GISTs from December 2002 to March 2008,and divided into two groups,that is ,open group and laparoscopic group,and analyzed the clinical data and compared these data.Results:The incision length, average intraoperative blood loss, the gastrointestinal function recovery time and postoperative hospital stay in laparoscopic group was less than those of the open group(3.3±1.2 vs 16.6±3.1 cm, 51.0±29.0 vs 119.0±139.0 ml, 2.4±0.9 vs 4.1±1.2 day, 6.9±1.9 vs 10.8±2.7 day).There was significant difference between two groups (P<0.05).However,the operative time, the rate of the complications,the motality,the recurrence rate and tolal treatment cost had no significant difference(141.0±52.0 vs 144.0±71.0 min, 0% vs 0%, 3.8% vs 17.1%, 3.8% vs 5.7%, 0% vs 2.9%, 21886.0±3118.0 vs 20201.0±6724.0 yuan, P>0. 05).ConcIusions:Compared with the open procedure, the laparoscopic surgery had less trauma and recovered more quickly,with similar recurrenc rate and tolal treatment cost.So the laparoscopic surgery is feasible to the gastric gastrointestinal stromal tumors.