The Study Of Risk Stratincation Schemes And Oncologic Outcome Of Laparoscopic Resection Of Gastrointestinal Stromal Tumor(GIST)

Gastrointestinal stromal tumors (GIST) have varying malignancy. Recently many clinical trials at home and abroad demonstrated that the varying malignancy of GIST not only relates to the prognosis, but also the appropriate application of adjuvant therapy of imatinib. The Clinical Trial ACOSOG-Z9001proved that patients with high or intermediate risk have longer recurrence-free survival due to adjuvant imatinb therapy. In the China2011consensus of GIST, the patients with high or intermediate risk are also recommended adjuvant imatinb. The ability to accurately estimate the risk of recurrence has important guiding significance for adjuvant therapy after operation. However, the risk-stratification schemes have been revised. Furthermore, there are no enough evidence which scheme is more suitable for Chinese GIST patinents. Considering the fact that difference in the clinical use of schemes may lead to misclassification risk, it is necessary to assess the value of application of different classification criteria in Chinese patients with GIST. Based on the reasons above, this paper aims at exploring the application value in domestic GIST risk assessment of the three kinds of risk-stratification schemes commonly used in the world:Fletcher, Miettinen and NIH2008consensus (Referred to as NIH2008).GIST can occur in any organ in the digestive tract, but most often occurs in the stomach(about60-70%). Recently it’s demonstrated that almost all of the gastric stromal tumors have potential malignancy. They tend to cause swelling of the growth of oppression, rather than the invasive growth, and very few violations of adjacent organs. Gastric stromal tumors are not sensitive to radiotherapy and chemotherapy, so surgical resection remains the primary treatment. Furthermore, gastric stromal tumors are not recommended systematic lymph node dissection, due to a rare lymphatic infiltration. These biological characteristics of gastric stromal tumor make it very suitable for laparoscopic resection. It has been nearly20years since the first case of laparoscopic resection of gastric stromal tumor. After that, the number of relevant reports is growing. However, the safety, feasibility and oncologic outcome of the laparoscopic approach remain controversial. Our research aims at assessing the safety and feasibility, and the oncologic outcome of laparoscopic resection of gastric stromal tumor by comparing it with open resection.Part I The application value of three risk-stratification schemes in Chinese patients with gastrointestinal stromal tumorsObjective:To evaluate the application value of three risk-stratification schemes in domestic GIST risk assessment.Methods:The clinical data of144patients with GIST who were admitted to our hospital from January2008to December2010were analyzed retrospectively.144cases GIST were evaluated for their biologic potential by the risk-stratification schemes of Fletcher, NIH2008, and among those,119cases GIST were evaluated by the risk-stratification schemes of Miettinen. Fletcher and Miettinen were compared by Kaplan-Meier survival analysis. The Logistic regression model was established to analyze the comparison of Miettinen and NIH2008.Result:(1) According to Fletcher. in the intermediate risk GIST. the recurrence-free survival (RFS) of non gastric(small intestinal,rectal and so on) GIST and gastric GIST has statistical difference (P=0.001). According to Miettinen, in the risk subgroup of GIST, the recurrence-free survival of different location of GIST has no statistical difference(P>0.05).(2)Logistic regression model judgment rate: Miettinen (89.4)> NIH2008(85.2).Conclusions:Our findings suggested that:Fletcher scheme is simple and easy to use, but may misjudge the prognosis of the GIST in different part; Miettinen scheme may be a potential supplementary way of NIH2008scheme in domestic GIST risk assessment. Part Ⅱ Comparative study on Laparoscopic versus Open resection of gastric stromal tumorsObjective:To explore the safety and feasibility,and the oncologic outcome of laparoscopic resection of gastric stromal tumors by comparing it with open resection.Methods:From January2008to December2010, a prospective comparative study was performed comparing75patients underwent for gastric stromal tumors in our hospital. They were divided into two groups.The medical record of the patients were reviewed retrospectively with regard to operating time,time to liquid, duration of hospital and so on.Those clinical data were compared between those two group.Result:In the meantime, laparoscopic resection were performed in37patients, open resections were done in38patients. The operative time,blood loss, exhaust time, time to liquid, time to semi-liquid, postoperative hospital stay in laparoscopic group was less than those of the open group (70±67min vs.140.5±56.8min,10±30ml vs.100±150ml,3.1±1.5days vs.4.5±1.2days,3.2±1.5days vs.5.4±1.3days,4.7±1.6days vs.7.2±1.6days,7.0±3.0days vs.12.3±8.7days). There was significant difference between these two groups (P<0.05). The Clavien-Dindo Grade of operative complications had no significant difference(P=0.449). Recurrence rate, motality rate, and3year reccurence-free rate had no significant difference(2.7%vs.7.9%,2.7%vs.5.3%,97.2%vs.91.2%, P>0.05).Conclusion:Compared with the open procedure, laparoscopic resection of gastric stromal tumor has less trauma and recovered more quickly, with similar recurrence rate. Therefore, the laparoscopic surgery is safe, feasible, and its oncologic outcome is similar with open surgery.