Comparative Study On Clinical Efficacy Of Two Surgical Methods For Gastric Gastrointestinal Stromal Tumors At Unfavorable Position

Objective To investigate the safety and feasibility of Laparoscopy in the treatment of gastric gastrointestinal stromal tumor(GIST)at unfavorable positions.Methods A retrospective cohort study was conducted to analyze the clinical data of patients with gastric GIST at unfavorable positions confirmed by pathology after surgery(Laparoscopy or Laparotomy)at the Southwest Hospital of the Army Medical University and the Minda Hospital of Hubei Minzu University from June 2008 to June 2018.A total of 244 patients(238 in Southwest Hospital and 6 in Minda Hospital)were enrolled,including 122 males and 122 females with the age of 41-70 years.Operative methods should be adopted according to patients’ wishes.There were 146 cases in the Laparoscopy surgery group and 98 cases in the open surgery group.The intraoperative blood loss,operative time,postoperative first flatus time,postoperative first feeding time,average hospital stay,morbidity of postoperative complication,1-,3-,and5-year recurrence-free survival(RFS)and overall survival(OS)rate were compared between the two groups.Results There were no significant differences in sex,age,tumor size,tumor risk grade or growth pattern between the Laparoscopy and the open surgery groups(all P>0.05),and these two groups were comparable.Compared with open group,Laparoscopy group had shorter incision lengths(5±2.4)cm vs.(18.7±3.4)cm(t=36.900,P<0.001),less intraoperative blood loss(31.4±2.3)ml vs.(143.9±3.7)ml(t=292.800,P<0.001),shorter postoperative first flatus time(2.1±0.7)days vs.(3.8±0.8)days,(t=17.550,P<0.001),shorter postoperative first feeding time(2.1 ± 0.5)days vs.(2.3±1.7)days(t=1.339,P=0.020),shorter hospital stay(8.6±2.6)days vs.(13.6 ± 3.2)days(t=13.410,p<0.001),and lower morbidity of postoperative complication [16(11.0%)vs.21(21.4%),χ2 =4.996,P=0.025],whose differences were statistically significant.While the operation time was similar in two groups[(124.7±15.8)minutes vs.(120.9±14.5)minutes,t=1.903,P=0.058].The median follow-up of all the patients was 43(1 to 119)months.In Laparoscopy group and open group,the 1-,3-and 5-year RFS were 94.5% vs.93.9%,91.1% vs.90.8%,and82.2% vs.81.6%,respectively,and 1-,3-and 5-year OS were 98.6% vs.95.9%,95.9% vs.94.9%,and 91.1% vs.88.8%,respectively,whose differences were not statistically significant(all p>0.05).Conclusion In the experienced gastrointestinal surgery center,Laparoscopy resection of gastric GIST at unfavorable position is safe and feasible,achieving the same efficacy of open surgery.