Laparoscopic versus open surgery for gastric gastrointestinal stromal tumors: what is the impact on postoperative outcome and oncologic results?
| Autor: | Olivier Glehen, Alain Duhamel, Bernard Meunier, Jean-Pierre Bail, Pascale Mariani, Léon Maggiori, Thierry Perniceni, Cécile Brigand, Magalie Cabau, Jean-Marc Regimbeau, Guido A. M. Tiberio, N. Regenet, Léonor Benhaim, Guillaume Piessen, Jean-Yves Mabrut, Jérémie H. Lefevre, Gilles Manceau, Jack Porcheron, Sylvie Bonvalot, Christophe Mariette, Didier Mutter, Antoine Guillaud, Hélène Behal, Muriel Mathonnet, Quentin Denost |
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| Jazyk: | angličtina |
| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Gastrointestinal Stromal Tumors medicine.medical_treatment Postoperative Complications Gastrectomy Stomach Neoplasms Anesthesiology medicine Humans Postoperative outcome Hospital Mortality Postoperative Period Laparoscopy medicine.diagnostic_test GiST business.industry Open surgery Odds ratio Middle Aged Surgery Europe Treatment Outcome Propensity score matching Feasibility Studies Female business Follow-Up Studies |
| Popis: | OBJECTIVES The aim of the study was to compare the postoperative and oncologic outcomes of laparoscopic versus open surgery for gastric gastrointestinal stromal tumors (gGISTs). BACKGROUND The feasibility of the laparoscopic approach for gGIST resection has been demonstrated; however, its impact on outcomes, particularly its oncologic safety for tumors greater than 5 cm, remains unknown. METHODS Among 1413 patients treated for a GIST in 61 European centers between 2001 and 2013, patients who underwent primary resection for a gGIST smaller than 20 cm (N = 666), by either laparoscopy (group L, n = 282) or open surgery (group O, n = 384), were compared. Multivariable analyses and propensity score matching were used to compensate for differences in baseline characteristics. RESULTS In-hospital mortality and morbidity rates in groups L and O were 0.4% versus 2.1% (P = 0.086) and 11.3% vs 19.5% (P = 0.004), respectively. Laparoscopic resection was independently protective against in-hospital morbidity (odds ratio 0.54, P = 0.014). The rate of R0 resection was 95.7% in group L and 92.7% in group O (P = 0.103). After 1:1 propensity score matching (n = 224), the groups were comparable according to age, sex, tumor location and size, mitotic index, American Society of Anesthesiology score, and the extent of surgical resection. After adjustment for BMI, overall morbidity (10.3% vs 19.6%; P = 0.005), surgical morbidity (4.9% vs 9.8%; P = 0.048), and medical morbidity (6.2% vs 13.4%; P = 0.01) were significantly lower in group L. Five-year recurrence-free survival was significantly better in group L (91.7% vs 85.2%; P = 0.011). In tumors greater than 5 cm, in-hospital morbidity and 5-year recurrence-free survival were similar between the groups (P = 0.255 and P = 0.423, respectively). CONCLUSIONS Laparoscopic resection for gGISTs is associated with favorable short-term outcomes without compromising oncologic results. |
| Databáze: | OpenAIRE |
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