The Clinical Research On Application Of Laparoscopic Resection For Gatric Stromal Tumor

Objective:To evaluate the feasibility, safety and outcomes of laparoscopic resection for gastric stromal tumor by comparison with open resection.Methods:According to inclusion and exclusion criteria, the clinical data of all gastric stromal tumor patients who received surgery at our institution from October2007to March2013were retrospectively analyzed. According to the surgery methods, the patients were divided to laparoscopic surgery group(LAP) and open surgery group(OPEN). The major data includes operation time, blood loss, first flatus time, first liquid diet time, first semiliquid diet time, post operative in-hospital days, post operative complications and long-term relapse-free survival. Then compare the feasibility, safety and outcomes of LAP with OPEN. A subgroup analysis of patients whose tumor size is not larger than5cm is performed.Results:Under the inclusion and exclusion criteria, there were62cases in the LAP group and67cases in the OPEN group. There were no significant differences between these two groups with respect to sex, age, BMI index and ASA status. The tumor size was smaller in LAP group than in OPEN group (3.7±2.7cm vs6.3±5.4cm, P<0.01), and the Mitotic rate, risk stratification and tumor resection method was significantly different between the two groups. The LAP group was associated with shorter operation time (121.1±42.5min vs145.7±73.3mi, P=0.02), less blood loss (82.8±87.2ml vs194.0±170.9ml, P<0.01), shorter first flatus time(2.5±0.9d vs3.4±0.9d, P<0.01), shorter first liquid diet time (3.3±1.1d vs4.4±1.1d, P<0.01), shorter first semiliquid diet time (4.9±1.6d vs6.7±2.1d, P<0.01), shorter post operative hospital stay (6.2±2.0d vs9.5±5.6d, P<0.01) and lower risk of postoperative complications (8.1%vs20.1%, P=0.04), compared with OPEN group. The5-year relapse-free survival suggested no significant differences between the two groups. The subgroup analysis showed no significant differences between the two groups with respect to mitotic rate, risk stratification, tumor size and tumor resection method. The LAP group was associated with less blood loss (79.2±88.4ml vs153.3±125.1ml, P<0.01), shorter first flatus time (2.4±0.9d vs3.3±0.9d, P<0.01), shorter first liquid diet time3.2±1.0d vs4.2±0.9d, P<0.01), shorter first semiliquid diet time (4.9±1.6d vs6.4±1.8d, P<0.01), shorter post operative hospital stay (6.2±2.2d vs8.7±5.0d, P<0.01). The operation time and risk of postoperative complications was similar between the two groups.Conclusions:Comparing with open surgery, laparoscopic resection has the advantage of less blood loss, minimal invasive and quick post operative recovery. We believe that it is a safe, useful, and less invasive alternative for the treatment of gastric stromal tumor. Laparoscopic transgastric resection is simple, safe, and effective for intraluminal gastric stromal tumor located near the EGJ and can avoid the deformity or stenosis in gastric inlet.