Laparoscopic resection for high-risk gastric gastrointestinal stromal tumors: safety and oncological outcome

Minimally invasive treatment for high-risk gastrointestinal stromal tumor (GIST) remains controversial for the concerns including intra-operative rupture and tumor spillage. This study aimed to compare the long-term oncological outcomes in the high-risk GIST patients receiving laparoscopic and open surgery.

We conducted a retrospective study on patients with high-risk GISTs of the stomach undergoing curative resection by laparoscopic or open approach from 2002 to 2024 at a single medical center. Propensity score matching was applied to adjust for tumor size and tumor location between these two groups at a 1:1 ratio. We evaluated the peri-operative and long-term oncological outcomes.

There were 184 patients with high-risk GISTs of the stomach recruited. The clinical demographics including age and gender were similar between the laparoscopic and open groups. The mean tumor size was significantly larger in the open group (13.4 ± 7.4 cm versus 5.7 ± 3.5 cm, p < 0.001). After matching, 34 patients in each group were analyzed with comparable tumor sizes and locations. The laparoscopic group was associated with a shorter hospital stay (9.7 ± 2.3 days versus 12.4 ± 4.0 days, p = 0.013). Otherwise, the operation time, blood loss, and the ratio of receiving adjuvant target therapy were similar between groups. Kaplan-Meier RFS analysis showed no difference between the open and laparoscopic groups either in 10-year RFS (82.7% versus 73.6%, p = 0.739) or 10-year OS (90.0% versus 96.9%, p = 0.588). Multivariate analysis showed the surgical approach was not a significant risk factor affecting RFS or OS.

Laparoscopic resection is a safe and feasible surgical approach in selected gastric high-risk GIST patients, providing comparable oncologic outcomes to open surgery with a shorter hospital stay.