A multi-centre analysis of the impact of updated risk stratification on follow-up of gastric gastro-intestinal stromal tumours in the post-imatinib era

Systematic review of current prognostication systems for primary gastrointestinal stromal tumors

BACKGROUND

The advent of tyrosine kinase inhibitors as adjuvant therapy has revolutionized the management of GIST and emphasized the need for accurate prognostication systems. Numerous prognostication systems have been proposed for GIST but at present it remains unknown which system is superior. The present systematic review aims to summarize current prognostication systems for primary treatment-naive GIST.

METHODS

A literature review of the Pubmed and Embase databases was performed to identify all published articles in English, from the 1st January 2002 to 28th Feb 2017, reporting on clinical prognostication systems of GIST.

RESULTS

Twenty-three articles on GIST prognostication systems were included. These systems were classified as categorical systems, which stratify patients into risk groups, or continuous systems, which provide an individualized form of risk assessment. There were 16 categorical systems in total. There were 4 modifications of the National Institute of Health (NIH) system, 2 modifications of Armed Forces Institute of Pathology (AFIP) criteria and 3 modifications of Joensuu (modified NIH) criteria. Of the 7 continuous systems, there were 3 prognostic nomograms, 3 mathematical models and 1 prognostic heat/contour maps. Tumor size, location and mitotic count remain the main variables used in these systems.

CONCLUSION

Numerous prognostication systems have been proposed for the risk stratification of GISTs. The most widely used systems today are the NIH, Joensuu modified NIH, AFIP and the Memorial Sloan Kettering Cancer Center nomogram. More validation and comparison studies are required to determine the optimal prognostication system for GIST.

Laparoscopic Versus Open Resection of Gastric Gastrointestinal Stromal Tumors Larger Than 5 cm: A Single-Center, Retrospective Study

BACKGROUND

The technical feasibility and oncological safety of laparoscopic surgery for gastric gastrointestinal stromal tumors (GISTs) larger than 5 cm has not been adequately studied. Therefore, we performed this retrospective study to investigate the clinical outcomes of gastric GIST patients treated with laparoscopic surgery compared with those who underwent open surgery.

METHODS

We retrospectively evaluated the outcomes of 48 consecutive patients who underwent gastric resection for gastric GISTs larger than 5 cm. The patients were divided into 2 groups based on the surgery performed: the laparoscopic resection group (LAPG) and the open resection group (OG). We assessed all available patient data, including baseline information, tumor characteristics, surgical outcomes, pathological results, postoperative complications, and long-term patient survival.

RESULTS

The 2 groups had similar baseline data. No differences were found in tumor size, location, mitotic count, and risk grade according to Fletcher's risk classification. The LAPG was superior to the OG in blood loss, time to first flatus, time to oral intake, and length of postoperative hospital stay. Perioperative complications, recurrence rate, and long-term survival, however, did not differ significantly between the groups. The mean operation time in the LAPG was 28 minutes longer than that in the OG.

CONCLUSIONS

In patients with primary gastric GISTs larger than 5 cm, laparoscopic resection is a technically feasible and oncologically safe surgery when performed by experienced surgeons.

Laparoscopic versus open gastric resection for larger than 5 cm primary gastric gastrointestinal stromal tumors (GIST): a size-matched comparison

BACKGROUND

Laparoscopic resection of gastric gastrointestinal stromal tumors (GISTs) appears technically feasible and associated with favorable outcomes. Tumor size plays an important role in surgical approach, with laparotomy tending to be used to treat larger tumors. This study evaluated the technical feasibility, safety, and oncologic efficacy of laparoscopic surgery for GISTs ≥5 cm in diameter.

METHODS

One hundred forty patients who underwent resection of primary gastric GIST at our institution from January 2007 to December 2012 were identified. Twenty-three patients with tumor larger than 5 cm in diameter treated by laparoscopic resection and were randomly matched (1:1) by tumor size (±1 cm) to patients with open resection. Clinical and pathologic variables and surgical outcomes for each surgical type were identified and compared.

RESULTS

There were no significant differences in clinicopathologic characteristics between the two groups. Laparoscopic group was superior to open group in operation time, blood loss, time to ground activities, time to first flatus, times to liquid diet, and postoperative stay (P < 0.05). Number of transfusions and time to semi-liquid diet, however, did not differ between groups. There was no operative mortality, and the postoperative complications were similar. Fifteen patients in the laparoscopic group and 17 patients in the open group received adjuvant treatment with imatinib. Recurrence or metastasis occurred in eight cases (three in the laparoscopic group and five in the open group). No significant difference in long-term disease-free survival was found between the two groups (P > 0.05).

CONCLUSION

When performed by experienced surgeons, laparoscopic resection for gastric GISTs larger than 5 cm is a safe and effective minimally invasive surgery.