ABSTRACT
Objective:
To investigate the
efficacy of different
laparoscopic surgeries for
gastrointestinal stromal tumors (GIST) of gastric
cardia and fundus.
Methods:
The retrospective
cohort study was conducted. The clinicopathological data of 251
patients with GIST of gastric
cardia and fundus
who underwent laparoscopic radical resection in 14 medical centers, including Guangdong Provincial People′s
Hospital et al, from December 2007 to December 2021 were collected. There were 123
males and 128
females,
aged 58(24,87)years.
Observation indicators (1)
treatment; (2) clinicopathological data of
patients undergoing different
laparoscopic surgeries; (3) subgroup
analysis for special laparoscopic
techniques. Measurement data with
normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test or
ANOVA.
Measure-ment data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the
Mann-Whitney U test or Kruskal-Wallis H test. Count data were described as absolute numbers or percentages. Comparison of ordinal data was conducted using the rank sum test.
Results:
(1)
Treatment. Of the 251
patients,202 cases underwent gastric wedge resection, 26 cases underwent special laparoscopic
techniques including 10 cases with serotomy and
dissection and 16 cases with transluminal
gastrectomy, 23 cases underwent structural
gastrectomy including 6 cases with total
gastrectomy and 17 cases with proximal partial
gastrectomy. There were 24
patients had
postoperative complications after
surgery. (2) Clinicopathological data of
patients undergoing different
laparoscopic surgeries. The
gender (
male,
female), age,
tumor diameter, operation
time, volume of intraoperative
blood loss, length of incision,
time to postoperative initial whole liquid
food intake,
time to postoperative initial semi-liquid
food intake, duration of postoperative
hospital stay, cases with perioperative
complications, cases with mitotic count as ≤5/50 high
power field, 6?10/50 high
power field, >10/50 high
power field, cases be classified as very low
risk, low
risk, medium
risk, high
risk according to the
National Institutes of Health risk classification, cases with
tumor located at fundus and gastric
cardia were 93, 109, (59±11)years, 3.50(0.40,10.00)cm, 88.00(25.00,290.00)minutes,20.00(25.00,290.00)mL, 4.00(2.00,12.00)cm, 3.00(1.00,9.00)days, 4.00(1.00,16.00)days, 5.00(1.00,18.00)days, 14, 164, 31, 7, 47, 83, 50, 22, 30, 172 in
patients undergoing gastric wedge resection, respectively. The above
indicators were 19, 7, (49±14)years, 2.55(0.20,5.00)cm, 101.00(59.00,330.00)minutes, 27.50(2.00,300.00)mL, 4.50(0,6.00)cm, 2.50(1.00,10.00)days, 4.00(1.00,16.00)days, 6.00(1.00,18.00)days, 3, 20, 5, 1, 15, 5, 2, 4, 24, 2 in
patients undergoing special laparos-copic
techniques, and 11, 12, (52±10)years, 5.00(0.80,10.00)cm, 187.00(80.00,325.00)minutes, 50.00(10.00,300.00)mL, 6.00(4.00,12.00)cm, 4.00(2.00,8.00)days, 6.00(3.00,14.00)days, 8.00(2.00,18.00)days, 7, 11, 5, 7, 2, 6, 6, 9, 13, 10 in
patients undergoing structural
gastrectomy. There were significant differences in the above
indicators among the three groups of
patients ( χ2=6.75, F=10.19, H=17.71, 37.50, 35.54, 24.68, 16.09,20.20, 13.76, χ2=13.32, Z=28.98, 32.17, χ2=82.14, P<0.05). (3) Subgroup
analysis for special laparoscopic
techniques. The
time to postoperative initial whole liquid
food intake,
time to postoperative initial semi-liquid
food intake,
classification of
tumor location (endophytic type, exophytic type, parietal type) were 4.50(1.00,10.00)days, 8.00(3.00,12.00)days, 0, 8, 2 in
patients undergoing serotomy and
dissection, versus 2.00(1.00,4.00)days, 3.00(1.00,6.00)days, 16, 0, 0 in
patients undergoing transluminal
gastrectomy. There were significant differences in
time to postoperative initial whole liquid
food intake,
time to postoperative initial semi-liquid
food intake between them ( Z=-2.65, -3.16, P<0.05); and there was a significant difference in
classification of
tumor location between them ( P<0.05).
Conclusions:
Gastric wedge resection is the most commonly used laparoscopic
technique for GIST of gastric
cardia and fundus. The application of special laparoscopic
techniques is focused on the GIST of
cardia to preserve the function of the
cardia.