Laparoscopic versus open gastric resections for gastric gastrointestinal stromal tumors: a meta-analysis

We conducted a meta-analysis to compare surgical and oncologic outcomes of patients with gastric gastrointestinal stromal tumors (GISTs) undergoing laparoscopic resection surgery (LAP) and open resection surgery (OPEN).

PubMed, Ovid, Web of Science, Cochrane, CNKI, and Chinese Biomedical Database were searched. Statistical analysis was carried out by RevMan 5.0 software. The quality of evidence was assessed by the Newcastle-Ottawa scale. A decision tree analysis model was constructed to evaluate the treatment strategy.

Seventeen studies involving 776 participants were included for the meta-analysis. The meta-analysis results showed that, compared with OPEN, LAP indicates potentially favorable outcomes in terms of intraoperative blood loss [weighted mean difference (WMD), -60.67; 95% confidence interval (95% CI), -116.66 to -4.69], time to first flatus (WMD, -1.19; 95% CI, -1.65 to -0.73), time to oral intake (WMD, -1.26; 95% CI, -1.89 to -0.63), and hospital stay (WMD, -2.62; 95% CI, -3.25 to -1.99). There were no differences in terms of the operative time, overall complication, and recurrence. Decision analysis showed that LAP was the strategy with a higher overall success (93%) compared with OPEN (88%).

This meta-analysis showed that LAP for gastric GISTs was associated with less blood loss, earlier return of bowel function, earlier resumption of diet, and shorter length of hospital stay when compared with OPEN; however, LAP and OPEN had similar operative time, overall complication, and recurrence. The LAP might be superior to OPEN for the patients with GIST <5 cm. Methodologically, high-quality comparative studies are needed for further evaluation.