Laparoscopic management and longterm outcomes of gastrointestinal stromal tumors

Surgery remains the standard for nonmetastatic gastrointestinal stromal tumors (GISTs). Laparoscopic surgery should be considered for these tumors, because their biologic behavior lends them to curative resection without requiring large margins or extensive lymph-adenectomies.

A retrospective review was performed of patients who underwent laparoscopic treatment of GISTs at Mount Sinai Medical Center from 2000 to 2007. Kaplan-Meier method was used for survival analysis. Chi-square analysis was used to identify factors associated with poor outcomes.

Laparoscopic surgery was attempted in 76 patients. The average age was 66 years, and 39 were men. Forty-two percent of patients presented with gastrointestinal bleeding. Tumors were located in the stomach (72%) and in the small bowel (28%). Mean tumor sizes were 4.2 and 3.9 cm, respectively. Operations included laparoscopic wedge resection (26%), partial gastrectomy (25%), sleeve (9%) gastrectomy, and small bowel resection (22%). Reasons for conversions (14%) were invasion of tumor into adjacent organs, adhesions, proximity to the gastroesophageal junction, large tumor size, or coincidental pathology. There was 1 mortality and a 10% morbidity rate, including an evisceration, obstruction, and pelvic hematoma requiring reoperation. Mean followup was 41 months (range, 3 to 102 months). The overall survival rate was 89%. Gastric and small bowel survival rates were the same (89%). The recurrence rate was 6%. The overall disease-free survival was 78% (77% gastric versus 82% small bowel). Three percent of patients died of metastatic disease. Adjuvant therapy was used on patients initially diagnosed with metastatic disease (n=5) and recurrent disease (n=4).

Laparoscopic resection of GISTs is considered safe and effective. The longterm disease-free survival of 78% establishes this minimally invasive approach as comparable to open techniques.