Laparoscopic versus open resection of gastric gastrointestinal stromal tumors

The aims of this study were to explore whether laparoscopic surgical resections of gastric gastrointestinal stromal tumors （GISTs） would produce better perioperative and similar oncologic outcomes compared with open surgical resection in Chinese patients. Thirty-six gastric GISTs cases were divided into a minimally invasive laparoscopic group and open resection group, depending on the surgical approach that was used. The general preoperative information, operative time, incision length, intraoperative blood loss, postoperative time to first flatulence, postoperative complications, postoperative hospital stay, total hospitalization costs, and such follow-up data as recurrence, metastasis, and mortality rates were compared between two groups. Among the 36 gastric GISTs, 15 received laparoscopic surgical treatment （laparoscopy group, n=15）, and 21 received routine open resection treatment （open resection group, n=21）. The laparoscopy group and the open resection group showed statistically significant differences （P〈0.05） in incision length （7.8±2.3 vs. 16.9±3.8 cm）, postoperative time to first flatulence （3.8±1.3 vs. 5.1±2.1 d）, postoperative hospitalization time （7.6±2.5 vs. 11.3±3.7 d）, and total cost of hospitalization （RMB 28,239±5,521 vs. RMB 23,761±5,362）. There were no statistically significant differences （P〉0.05） between the laparoscopy group and the open resection group in operative time （147.8±59.3 vs. 139.2±62.1 min） and intraoperative blood loss （149.8±98.9 VS. 154.2±99.3 mL）. Both groups had no postoperative complications, no recurrence and metastasis, and no postoperative mortality. There were no statistically significant differences between the two groups in postoperative complications, postoperative recurrence and metastasis, and postoperative mortality. In conclusion, compared with open resection, the laparoscopic resection of gastric GISTs offers the advantages of less trauma, faster recovery, and shorter hospital stay.

Comparison of Laparoscopy-Assisted Gastrectomy and Conventional Open Gastrectomy with the Same Procedure in Early Distal Gastric Cancer

Introduction: Laparoscopy-assisted gastrectomy (LAG) for early gastric cancer (EGC) was considered as a treatment with many advantages due to the application of laparoscopic equipment. The aim of this study was to compare the effect of use of laparoscopic equipment in blood loss, the number of harvested lymph nodes (HLNs), and complications between LAG and open gastrectomy (OG) for EGC. Methods: Patients received surgical treatment for early distal gastric cancer (EDGC) were retrospectively reviewed. Patients were classified into three groups by different operation methods: traditional open distal gastrectomy (ODG) group, laparoscopy-assisted distal gastrectomy (LADG) group, and open distal gastrectomy with assistance of laparoscopic equipment (ODGA) group. Results: Altogether 65 patients with EDGC received surgical treatment, including 20 cases of ODG, 22 of LADG, and 23 of ODGA. No lymph node metastasis was found in all patients. 25 (38.5%) postoperative confirmed T2 were misdiagnosed as T1 preoperatively. Compared with ODG group, the blood loss was significantly reduced in LADG and ODGA groups (106.4 ± 46.0;and 73.3 ± 35.7 ml vs. 250.5 ± 65.1 ml respectively;P 0.01), but the operation time was significantly longer in these groups (231.0 ± 34.5, and 222.5 ± 42.6 min vs. 128.5 ± 22.3 min respectively;P 0.01). No difference was found in the blood loss, operation time, the number of harvested lymph nodes and the types of gastrointestinal continuity reconstruction between LADG and ODGA groups. No difference was found in the postoperative complications among the three groups. Conclusions: Laparoscopic equipment might be the key factor in the reduction of blood loss and the delay of operation time for LADG. Application of laparoscopic equipment in open gastrectomy can be used as a training method to shorten learning curve for LAG beginners.