Meta-analysis comparing laparoscopic versus open resection for gastric gastrointestinal stromal tumors larger than 5 cm

Background The aim of this study was to conduct a meta-analysis comparing the safety and feasibility of laparoscopic versus open resection for gastric gastrointestinal stromal tumors (GISTs) larger than 5 cm. Method We searched the Cochrane Library, PubMed, and Embase for relevant articles. Randomized and nonrandomized clinical trials were identified and included in this study. Searching for related articles on large GIST (>5 cm) for laparoscopic resection (laparoscopic group [LAPG]) and open resection (open group [OG]), RevMan 5.3 was used for data analysis, comparing 2 groups of operation time, intraoperative blood loss, complications, length of hospital stay, recurrence rate, disease-free survival, and overall survival. Results Seven studies including 440 patients were identified for the meta-analysis. Meta-analysis revealed that LAPG had less bleeding, shorter postoperative hospital stay, and a better 5-year disease-free survival. There was no significant difference between LAPG and OG in operation time, postoperative complications, recurrence rate, and overall survival. Conclusion Laparoscopic resection of large (>5 cm) GIST is safe and feasible and has the advantages of less intraoperative blood loss and fast postoperative recovery, with a good outcome in the recent oncology.

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Meta-analysis of laparoscopic vs. open resection of gastric gastrointestinal stromal tumors

PLoS ONE ◽

10.1371/journal.pone.0177193 ◽

2017 ◽

Vol 12 (5) ◽

pp. e0177193 ◽

Cited By ~ 5

Author(s):

Liangying Ye ◽

Xiaojing Wu ◽

Tongwei Wu ◽

Qijing Wu ◽

Zhao Liu ◽

...

Keyword(s):

Gastrointestinal Stromal Tumors ◽

Meta Analysis ◽

Open Resection ◽

Stromal Tumors

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Laparoscopic versus open resection for gastric gastrointestinal stromal tumors: an updated systematic review and meta-analysis

World Journal of Surgical Oncology ◽

10.1186/1477-7819-12-206 ◽

2014 ◽

Vol 12 (1) ◽

pp. 206 ◽

Cited By ~ 18

Author(s):

Qi-Long Chen ◽

Yu Pan ◽

Jia-Qin Cai ◽

Di Wu ◽

Ke Chen ◽

...

Keyword(s):

Systematic Review ◽

Gastrointestinal Stromal Tumors ◽

Meta Analysis ◽

Open Resection ◽

Stromal Tumors

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Comparison Among Endoscopic, Laparoscopic, and Open Resection for Relatively Small Gastric Gastrointestinal Stromal Tumors (<5 cm): A Bayesian Network Meta-Analysis

Frontiers in Oncology ◽

10.3389/fonc.2021.672364 ◽

2021 ◽

Vol 11 ◽

Author(s):

Zhen Liu ◽

Ziyang Zeng ◽

Siwen Ouyang ◽

Zimu Zhang ◽

Juan Sun ◽

...

Keyword(s):

Bayesian Network ◽

Gastrointestinal Stromal Tumors ◽

Meta Analysis ◽

Random Effect Model ◽

Positive Margin ◽

Cochrane Library ◽

Open Resection ◽

Stromal Tumors ◽

Significant Difference

BackgroundEndoscopic resection (ESR) is a novel minimally invasive procedure for superficial tumors. Its safety, efficiency, and outcome for gastric gastrointestinal stromal tumors (gGISTs) less than 5 cm remains unclear compared to laparoscopic resection (LAR) and open resection (ONR). The current network meta-analysis aimed to review and analyze the available evidence of this question.MethodsPubMed, Embase, Cochrane Library, and Web of Science databases were searched to identify eligible studies published up to July 6, 2020. The perioperative and long-term oncological outcomes among ESR, LAR, and ONR for gGIST (<5 cm) were estimated through the Bayesian network meta-analysis with a random-effect model.ResultsFifteen studies with 1,631 patients were included. ESR was associated with a shorter operative time [mean difference, MD: -36; 95% confidence interval, CI (-55, -16)], a higher rate of positive margin [odds ratio, OR: 5.1 × 1010, 95% CI (33, 2.5 × 1032)], and less costs [MD: -1 × 104, 95% CI (-1.6 × 104, -4.4 × 103)] but similar time to resume flatus [MD: 0.52, 95% CI (-0.16, 1.1)] and diet [MD: -3.5, 95% CI (-5.6, -1.6)] compared to LAR. A higher rate of total complications [OR: 11, 95% CI (1.2, 140)] was observed in patients who received ESR compared to patients who received LAR. After excluding perforation from the total complication category, the difference of complication between ESR and LAR disappeared [OR: 0.87, 95% CI (0.22, 2.3)]. The recurrence rate [OR: 1.3, 95% CI (0.40, 4.5)] and disease-free survival [hazard ratio: 1.26, 95% CI (0.60, 2.63)] showed no significant difference between ESR and LAR. ESR was associated with better or equivalent perioperative and long-term outcomes compared to ONR, except for positive margin. A subgroup analysis (<2 and 2–5 cm) showed no significantly different results among these three procedures either.ConclusionESR was shown to be a safe and efficient alternative procedure to both LAR and ONR for gGISTs less than 2 cm and within 2–5 cm, respectively, without worsening the oncologic outcomes. However, preoperative assessment of tumor site is of importance for the determination of procedures regarding the increased incidence of a positive margin related to ESR.

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Laparoscopic versus Open Resection for Gastric Gastrointestinal Stromal Tumors: A Meta-analysis

The American Surgeon ◽

10.1177/000313481408000124 ◽

2014 ◽

Vol 80 (1) ◽

pp. 48-56 ◽

Cited By ~ 11

Author(s):

Lijun Zheng ◽

Weixing Ding ◽

Donglei Zhou ◽

Liesheng Lu ◽

Le Yao

Keyword(s):

Comparative Studies ◽

Gastrointestinal Stromal Tumors ◽

Laparoscopic Resection ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Cochrane Library ◽

Open Resection ◽

Stromal Tumors ◽

Gastric Gists ◽

Complications Rate

We conducted our meta-analysis to compare outcomes between laparoscopic resection and open resection for gastric gastrointestinal stromal tumors (GISTs) from all published comparative studies in the literature. Databases, including PubMed, Embase, Cochrane Library, Ovid, Web of Science, and CNKI, were searched to identify studies comparing outcomes after laparoscopic resection and open resection for gastric GISTs. The meta-analysis was performed by RevMan 5.1. Eleven comparative studies comprising 495 patients were identified. Patients undergoing laparoscopic resection of gastric GISTs were found to have similar operative time (weighted mean difference [WMD], 2.29; 95% confidence interval [CI], -16.01 to 11.43; P = 0.74) and complications rate (odds ratio [OR], 0.76; 95% CI, 0.36 to 1.58; P = 0.46). Less intraoperative blood loss (WMD, -55.91; 95% CI, -90.26 to -21.56; P = 0.001), earlier passing first flatus (WMD, -0.89, 95% CI, -1.60 to -0.18; P = 0.01), earlier having the first liquid diet (WMD, -1.54; 95% CI, -2.44 to -0.64; P = 0.0008), and shorter hospital stay (WMD, -4.25; 95% CI, -5.63 to -2.88; P < 0.00001) were observed in the laparoscopic resection group. The recurrence rate was higher in the group of open resection compared with the group of laparoscopic resection (OR, 0.26; 95% CI, 0.09 to 0.75; P = 0.01). Laparoscopic resection is safe and efficient in the treatment of patients with gastric GISTs as compared with open resection procedure. Laparoscopic resection may be a preferred treatment for gastric GISTs.

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