Study On The Feasibility And Safety Of Laparoscopic Surgery Of Gastric Stromal Tumors With Diameter Between 5 And 12cm

Objective:To discuss the feasibility and safety of laparoscopic surgery in the treatment of gastric stromal tumors with diameters between 5cm and 12cm by studying the difference in clinical efficacy between laparoscopic surgery and laparotomy in the treatment of gastric stromal tumors with diameters between 5cm and 12cm.Methods:The method of this study was retrospective cohort study.In this study,a total of 60 patients with pathologically confirmed gastric stromal tumor with diameter between 5cm and 12cm who were admitted to the Second Hospital of Shandong University from April 2012 to April 2018 were collected and screened according to inclusion and exclusion criteria.Among them,35 cases were treated with laparoscopic surgery(hereinafter referred to as laparoscopic group),and 25 cases were treated with laparotomy(hereinafter referred to as laparotomy group).Observation indexes included:(1)baseline data,including age,gender,BMI,ECOG score,tumor location,tumor size(in terms of long diameter length),risk grade,and immunohistochemical indexes.(2)perioperative indicators,including operation time,intraoperative blood loss,postoperative anal exhaust time,postoperative feeding time,postoperative hospitalization time,serum stress index(WBC?CRP?IL-6),early complication,etc.(3)follow-up data,including recurrence free survival rate,3-year survival rate,recurrence and metastasis treatment.Follow-up time of this study was up to December 2018.Statistical method:measurement data following a normal distribution are presented as mean±SD and were analyzed by T-test.Count data were analyzed by ?2 test or Fisher's exact test.A P-value<0.05 was considered statistical significance,and P-value?0.05 was considered no statistical significance.Results:There were no statistically significant differences between the laparoscopic group and the laparotomy group in age,gender,BMI,ECOG score,tumor location,tumor size and risk classification(P>0.05),and the two groups data were comparable.The laparoscopic group was significantly lower than the laparotomy group in terms of operation time,intraoperative blood loss,first anal exhaust time,postoperative feeding time,postoperative hospitalization days,and Visual analogue scale,WBC,CRP,and IL-6 on day 1 and 3 after surgery,with statistically significant differences(P<0.05).For tumors at favorable sites,the laparoscopic group was significantly lower than the laparotomy group in terms of operation time,intraoperative blood loss,time of first anal exhaust,postoperative feeding time,postoperative hospitalization days,and Visual analogue scale,WBC,CRP,and IL-6 on day 1 and 3 after surgery,with statistically significant differences(P<0.05).For tumors at adverse sites,the laparoscopic group was significantly lower than the laparotomy group in terms of operation time,intraoperative blood loss,time of first anal exhaust,postoperative feeding time,postoperative hospitalization days,and Visual analogue scale,WBC,CRP,and IL-6 on day 1 and 3 after surgery,with statistically significant differences(P<0.05).Among the patients in the laparoscopic group,the operation time,intraoperative blood loss and the first anal exhaust time of the patients in the favorable site group were all lower than those in the adverse site group,and the differences were statistically significant(P<0.05).There was no statistically significant difference between the two groups in the postoperative feeding time,postoperative hospitalization days,and Visual analogue scale,WBC,CRP,and IL-6 on day 1 and 3 after surgery(P>0.05).There was no significant difference between laparoscopic group and laparotomy group in early hospitalization complications,recurrence free survival rate and 3-year survival rate(P>0.05).Conclusion:Laparoscopic surgery is feasible,safe and effective for the treatment of gastric stromal tumor with a diameter between 5cm and 12cm.Compared with laparotomy surgery,laparoscopic surgery has the advantages of shorter operation time,less trauma and faster postoperative recovery.At the same time,laparoscopic surgery does not increase the incidence of perioperative complications compared with laparotomy surgery,and there is no significant difference between the long-term efficacy and open surgery.Laparoscopic treatment of the tumor at favorable parts has a shorter operation time,less bleeding advantages than the tumor at adverse parts.