Comparative Study On Laparoscopic Versus Conventional Resection Of Gastic Stromal Tumors

Background Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors arising from the GI tract. They can arise from any site in the gastrointestinal tract, but they most commomly occur in the stomach. GISTs are thought to originate from the interstitial cell of Cajal. Interstitial cells of Cajal and the vast majority of GIST express C-KIT. Prior to the identification and availability of immunohistochemistry for C-KIT, the majority of GIST were thought to be of smooth muscle origin and termed leiomyomas , leiomyosarcomas and leiomyoblastomas. It is now known that the majority of stromal tumors of the gastrointestinal tract are GIST. Ninety-five percent of GIST stain positive on immunohistochemistry for C-KIT, and the majority of GIST have a mutation in the C-KIT gene. Unlike most other cancers,GIST seem highly dependent on this single pathway for neoplastic growth. GISTs represent a rare but distinct histopathologic group of intestinal neoplasms of mesenchymal 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. KIT is mutated in a high proportion(approximately 85%) of patients with GIST. 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 the primary treatment of gastric GISTs. Because GISTs uncommonly metastasize to lymph nodes so extensive resections and regional lymphadenectomies are usually not required,thus for a pedunculated gastric tumor,wedge resection of the gastric wall along with resection of the tumor is adequate,some gastric tumors encompass a large portion of the stomach and a formal distal,subtotal,or even total gastrectomy may be 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 compared the relative efficacy of the two approaches and assessed the feasibility and efficacy and an efficient tissue-preserving technique for the removal of gastric GIST of the laparoscopic approach.Objective To investigate the outcomes and comparative study the relative efficacy of laparoscopic and conventional resection of gastric stromal tumors and assessed the feasibility and effectiveness of the laparoscopic approach.Methods Between January 2001 and December 2007, a prospective comparative study was performed comparing 33 patients underwent for gastric stromal tumors. Laparoscopic resections were performed in 15 patients; including 2 patients performed Laparoscopic with hand-port approach. Conventional resections were done in 18 patients. The medical record of the patients were reviewed retrospectively with regard to tumor size, operating time, time to liquid, duration of hospital stay and clinical course. Those clinical data were compared between those two groups. Results The tumor size, operative time, gastrointestinal function recovery time and postoperative hospital stay in laparoscopic group was less than those of the open group(3.24cm vs. 4.68 cm, 119.0min vs. 154.4min, 2.87 days vs. 4.78 days, 6.07 days vs. 13.11 days). There was significant difference between two groups (P<0.05). The intraoperative and postoperative complication rates, the motality and the recurrence rate had no significant difference (0% vs. 0%, 20.0% vs. 16.7%, 0% vs. 11.1 %, 0% vs. 0%, P>0.05).Conclusions Compared with the conventional resection procedure, the laparoscopic surgery had less trauma and recovered more quickly, with similar recurrenc rate. So the laparoscopic surgery is feasible to the gastric gastrointestinal stromal tumors.