Laparoscopic versus open surgery for gastric gastrointestinal stromal tumors: what is the impact on postoperative outcome and oncologic results?

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 5cm, 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 20cm (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 5cm, 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.