A systematic review and meta-analysis comparing laparoscopic versus open gastric resections for gastrointestinal stromal tumors of the stomach

Abstract

Background: This study is a systematic review and meta-analysis that compares the short- and long-term outcomes of laparoscopic gastric resection (LR) versus open gastric resection (OR) for gastric gastrointestinal stromal tumors (GISTs). Methods: Comparative studies reporting the outcomes of LR and OR for GIST were reviewed. Results: A total of 11 nonrandomized studies reviewed 765 patients: 381 LR and 384 OR. A higher proportion of high-risk tumors and gastrectomies were in the OR compared with LR (odds ratio, 3.348; 95 % CI, 1.248-8.983; p =.016) and (odds ratio,.169; 95 % CI,.090-.315; p <.001), respectively. Intraoperative blood loss was significantly lower in the LR group [weighted mean difference (WMD), -86.508 ml; 95 % CI, -141.184 to -31.831 ml; p <.002]. The LR group was associated with a significantly lower risk of minor complications (odds ratio,.517; 95 % CI,.277-.965; p =.038), a decreased postoperative hospital stay (WMD, -3.421 days; 95 % CI, -4.737 to -2.104 days; p <.001), a shorter time to first flatus (WMD, -1.395 days; 95 % CI, -1.655 to -1.135 days; p <.001), and shorter time for resumption of oral intake (WMD, -1.887 days; 95 % CI, -2.785 to -.989 days; p <.001). There was no statistically significant difference between the two groups with regard to operation time (WMD, 5.731 min; 95 % CI, -15.354-26.815 min; p =.594), rate of major complications (odds ratio,.631; 95 % CI,.202-1.969; p =.428), margin positivity (odds ratio,.501; 95 % CI,.157-1.603; p =.244), local recurrence rate (odds ratio,.629; 95 % CI,.208-1.903; p =.412), recurrence-free survival (RFS) (odds ratio, 1.28; 95 % CI,.705-2.325; p =.417), and overall survival (OS) (odds ratio, 1.879; 95 % CI,.591-5.979; p =.285). Conclusions: LR results in superior short-term postoperative outcomes without compromising oncological safety and long-term oncological outcomes compared with OR. © 2013 Society of Surgical Oncology.