Laparoscopic approach for the management of gastrointestinal stromal tumours (GIST) of the stomach
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296 Hellenic Journal of Surgery 2012; 84: 5
Laparoscopic Approach for the Management of Gastrointestinal Stromal Tumours (GIST) of the Stomach Systematic Review P. Ch Stathakis, G. D Ayiomamitis, Ch. Tsigris Received 26/03/2012 Accepted 24/07/2012
Abstract Aim-Background: The present review of the literature evaluates whether laparoscopic resection of gastric GISTs can become the new ‘gold standard’ treatment, analyzing perioperative characteristics and long-term oncological outcome. Surgery remains the standard treatment for non-metastatic gastrointestinal stromal tumours (GISTs). Laparoscopic surgery is considered a suitable option, since the biological behaviour of these tumours allows for curative resection without the necessity for large margins or extensive lymphadenectomies. Methods: A systematic review of gastrointestinal stromal tumours of the stomach treated by laparoscopy was conducted. Results: Up to 2008, laparoscopic surgery was attempted in 442 patients, of whom 254 were male and 188 female. Their average age was 61 years. The mean tumour size was 4.3 cm (1.0-7.5 cm); operative time ranged from 49-194.3 min, blood loss from 15196ml, and hospital stay from 2.3 up to 12.2 days. All lesions had negative resection margins. The followup period for all patients ranged from 19 up to 61 months while the overall survival was 82%. Conclusions: The review of the literature concurred that laparoscopic resection is safe and effective in treating gastric GISTs. Taking into consideration the associated benefits of this minimally invasive approach, laparoscopic surgery should be considered in the surgical treatment of small- and medium-sized gastrointestinal stromal tumours of the stomach.
Key words:
GIST, Laparoscopy, Stomach, Gastrointestinal stromal tumors
nal stromal tumour” in 1983 to identify a particular group of tumours [1]. Recently, C-kit tyrosine kinase (CD117) has been shown to be expressed in 91-99% of the GISTs [2], rendering it a useful and accurate diagnostic marker. With a projected annual incidence of 10–20 cases per one million inhabitants, gastrointestinal stromal tumours (GISTs) are the most common mesenchymal neoplasms of the digestive tract [3,4]. It is thought that GISTs most likely originate from precursor cells of the interstitial cells of Cajal. Their foremost characteristic is the gain-of-function mutation of the c- KIT receptor tyrosine kinase gene, which is considered to be the driving force in the cell proliferation of this tumour [5]. The clinical presentation of GISTs ranges from tumours with an indolent course and hardly any proliferation to fast-growing, recurring and metastasizing tumours [6]. Fletcher et al. proposed a classification of aggressive behaviour for GISTs based on their maximum diameter and mitotic rate [7] (Table 1), factors which were both shown to predict recurrence and survival [8,9]. Table 1 Classification of aggressive behaviour of GISTs proposed by Fletcher et al [7]
Very low risk
Tumor size (Largest diameter), cm
Mitotic count per 50 high power fields
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