Laparoscopic removal of GIST

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New research reported in the recent issue of the Journal of the American College of Surgeons shows that laparoscopic removal of gastrointestinal stromal tumors (GISTs) is safe and effective, with a disease-free survival rate of nearly 80 percent after an average follow-up time of three and a-half years.

GIST is a type of cancer arising from special cells in the wall of the gastrointestinal tract that help coordinate the muscular movement of digestive organs. Each year, between 4,500 and 6,000 cases of GIST are diagnosed in the United States. Laparoscopic surgery is an attractive alternative to traditional "open" surgery the therapy of choice for GISTs that have not spread to nearby organs since it is requires smaller abdominal incisions and therefore appears to be safer and result in a quicker recovery.

"Based on our data, which represents the largest retrospective series of GIST patients reported to date, we think that laparoscopic resection is feasible in the management of these tumors, carries no additional risks and has comparable results to the open approach," said Celia Divino, MD, FACS, Chief, Division of General Surgery at The Mount Sinai Medical Center, New York, N.Y.

Parissa Tabrizian, MD, further noted that, "The biologic behavior of GISTs makes them amenable to laparoscopic resection because they do not require removal of large amounts of tissue or lymph nodes".

Scientists conducted a retrospective study to evaluate long-term outcomes and survival in 76 patients who underwent laparoscopic therapy of GIST. Tumors were located in the stomach (72 percent) and the small bowel (28 percent).

At a mean follow-up of 41 months (range, 3 to 102 months), the overall disease-free survival rate was 78 percent (77 percent for gastric tumors and 82 percent for small bowel tumors). Three percent of patients died of metastatic disease, and nine percent of patients died from other unrelated causes. In comparison with patients with gastric GISTs, those with small bowel tumors had overall better outcomes, with no deaths or disease recurrence. Recurrent disease was seen in four patients with gastric tumors, and there was disease-specific mortality in two patients. There was no difference in overall survival between patients with small bowel and gastric tumors (89.5 percent versus 88.7 percent, respectively, p>0.165).


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