Meta-Analysis
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jan 15, 2018; 10(1): 48-55
Published online Jan 15, 2018. doi: 10.4251/wjgo.v10.i1.48
Comparison between laparoscopic and open surgery for large gastrointestinal stromal tumors: A meta-analysis
Jian-Xin Cui, Yun-He Gao, Hong-Qing Xi, Ai-Zhen Cai, Ke-Cheng Zhang, Ji-Yang Li, Bo Wei, Lin Chen
Jian-Xin Cui, Yun-He Gao, Hong-Qing Xi, Ai-Zhen Cai, Ke-Cheng Zhang, Ji-Yang Li, Bo Wei, Lin Chen, Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Cui JX, Gao YH and Xi HQ contributed equally to this work; Wei B and Chen L conceived the project; Cui JX and Gao YH independently searched references and took charge of data extraction and statistical analysis; Xi HQ searched references and extracted the parameters from each study; Cai AZ, Zhang KC and Li JY participated in the manuscript revision; all authors read and approved the final manuscript.
Supported by National Program on Key Basic Research Project of China, No. 2014CBA02002; National Key Research and Development Plan, No. 2016YFC0905302; National Natural Science Foundation of China, Nos. 81672319 and 81602507; and Beijing Municipal Science and Technology Project, No. D131100005313010.
Conflict-of-interest statement: This work was presented as an e-poster at the 12th International Gastric Cancer Congress (IGCC), April 20-23, 2017. We have no financial relationship to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Lin Chen, MD, PhD, Professor, Department of General Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China. chenlin@301hospital.com.cn
Telephone: +86-10-66938128 Fax: +86-10-66938128
Received: October 23, 2017
Peer-review started: October 24, 2017
First decision: November 23, 2017
Revised: December 4, 2017
Accepted: December 6, 2017
Article in press: December 6, 2017
Published online: January 15, 2018
Processing time: 80 Days and 18.7 Hours
Abstract
AIM

To investigate whether laparoscopic surgery is as safe and feasible as open resection for patients with larger gastrointestinal stromal tumors (GISTs) (≥ 5 cm).

METHODS

A systematic search of PubMed, EMBASE, Web of Science and the Cochrane Library database was performed. Relevant studies of laparoscopic and open surgery for GISTs of > 5 cm published before December 2016 were identified from these databases. The quality of the studies was assessed by the Newcastle-Ottawa Quality Assessment Scale. The tumor size, operation time, blood loss, postoperative hospital stay, complication rate, and disease-free survival rate were assessed. The software Stata (version 12.0) was used for the meta-analysis.

RESULTS

Five clinical trials comprising 209 patients with GISTs of similar larger sizes were evaluated. The pooled analysis of 100 patients in the laparoscopic resection group and 109 patients in the open resection group demonstrated that laparoscopic surgery was significantly associated with a shorter postoperative hospital stay (P < 0.001) and less blood loss (P = 0.002). Moreover, there were no statistically significant differences in the operation time (P = 0.38), postoperative complication rate (P = 0.88), or disease-free survival rate (P = 0.20) between two groups.

CONCLUSION

Our findings revealed that for patients with large GISTs of comparable sizes, laparoscopic surgery did not significantly influence the operation factors or clinical outcomes compared with open surgery. This suggests that laparoscopic resection is as acceptable as open surgery for treatment of large gastric GISTs.

Keywords: Laparoscopic resection; Open resection; Gastrointestinal stromal tumor; Meta-analysis; Clinical outcome

Core tip: Whether laparoscopic resection is also effective and feasible for treatment of larger gastric gastrointestinal stromal tumors (GISTs) (> 5 cm) remains unknown. This meta-analysis collected up-to-date clinical data of comparison of laparoscopic and open resection for larger gastric GISTs (> 5 cm). Our results showed that laparoscopic resection is an upgraded minimal invasive technique with a shorter postoperative hospital stay and less intraoperative blood loss compared with open surgery in treating patients with larger GISTs.