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Comparative Study
. 2024 Nov;38(11):6854-6864.
doi: 10.1007/s00464-024-11152-8. Epub 2024 Aug 23.

Oncologic outcomes and survival of modern surgical approaches for gastric gastrointestinal stromal tumor (GIST)

Hadley D Freeman  1 , Ross Mudgway  2 , Zachary Tran  2 , Rachael Kim  2 , Sharon S Lum  2 , Jukes P Namm  2 , Michael P O'Leary  2 , Mark E Reeves  2 , Esther Wu  2 , David Caba Molina  2
Affiliations
Comparative Study

Oncologic outcomes and survival of modern surgical approaches for gastric gastrointestinal stromal tumor (GIST)

Hadley D Freeman et al. Surg Endosc. 2024 Nov.

Abstract

Background: Studies have demonstrated comparable outcomes between laparoscopic and open resection of gastrointestinal stromal tumor (GIST). We sought to compare outcomes among robotic, laparoscopic, and open resection of gastric GIST in the era of expanding minimally invasive surgery.

Methods: A retrospective analysis was performed of adult patients with gastric GIST undergoing definitive surgery using the National Cancer Database from 2010 to 2020, excluding cases converted to open. Patients were stratified into minimally invasive surgery (MIS), (combined robotic (R) and laparoscopic (L)), and open (O). Hospital length of stay (LOS), 30-day mortality, 90-day mortality, and margin status were assessed. Subgroup analysis was performed to evaluate outcomes between R and L cohorts. Entropy balancing was used to adjust for intergroup differences. Kaplan-Meier survival estimates were used to compare unadjusted 5-year survival.

Results: Of the 15,022 patients (R = 10.4%, L = 44.3%, O = 45.3%), 63.2% were stage I and 70.6% underwent partial gastrectomy. MIS approach was associated with shorter hospital LOS (β: - 2.58; 95% CI: - 2.82 to - 2.33) and lower odds of 30-day (OR 0.45; 95% CI: 0.30-0.68) and 90-day mortality (OR 0.54; 95% CI: 0.39-0.74) compared to O. Likelihood of R0 resection similar between groups (OR 1.00; 95% CI: 0.88-1.14). Hospital LOS (β: + 0.25; 95% CI: - 0.14-0.64), odds of 30-day (OR 0.99; 95% CI: 0.40-2.46) and 90-day mortality (OR 0.89; 95% CI: 0.47-1.70), and rate of R0 resection (OR 1.02; 95% CI: 0.82-1.27) were comparable between R and L cohorts. Compared to O, MIS approach was associated with improved 5-year OS (log rank p < 0.001). Overall survival was not significantly different between R and L (log rank p = 0.44).

Conclusion: These findings suggest that MIS approach may be considered for resection of gastric GIST in select patients. Among patients receiving an MIS approach, the robotic technique can be considered an oncologically safe alternative to laparoscopic surgery.

Keywords: GIST; Laparoscopic; Minimally invasive surgery; Robotic.

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Conflict of interest statement

Drs. Hadley Freeman, Ross Mudgway, Zachary Tran, Sharon Lum, Jukes Namm, Michael O’Leary, Mark Reeves, Esther Wu, David Caba Molina, and Ms. Rachael Kim have no conflicts of interest or financial ties to disclose. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Figures

Fig. 1
Fig. 1
Case selection and inclusion criteria
Fig. 2
Fig. 2
Trends in operative approach for gastric GIST (2010–2020)
Fig. 3
Fig. 3
Outcomes based on entropy balancing (MIS vs. Open)
Fig. 4
Fig. 4
Kaplan–Meier estimated unadjusted 5-year overall survival, MIS versus Open
Fig. 5
Fig. 5
Outcomes based on entropy balancing (Robotic vs. Laparoscopic)
Fig. 6
Fig. 6
Kaplan–Meier estimated unadjusted 5-year overall survival, Robotic versus Laparoscopic
See this image and copyright information in PMC

References

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