Trends and Predictors of Failure of Minimally Invasive Surgery for Gastric GIST
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RESEARCH COMMUNICATION
Trends and Predictors of Failure of Minimally Invasive Surgery for Gastric GIST Brendan L. Hagerty 1 & Madeline B. Torres 1,2 & Justin Drake 1,3 & Jonathan M. Hernandez 1 & John E. Mullinax 4 & Andrew M. Blakely 1 & Jeremy L. Davis 1 Received: 16 June 2020 / Accepted: 30 September 2020 # 2020 The Society for Surgery of the Alimentary Tract (This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply)
Keywords GIST . Minimally invasive surgery . Gastric surgery . NCDB
Introduction
Methods
Complete resection (R0) with preservation of tumor pseudocapsule and gastric function is the accepted treatment for early-stage gastric gastrointestinal stromal tumor (GIST). Minimally invasive surgery (MIS) for gastric GIST is recommended in patients with tumors less than 5 cm in size and located in favorable anatomic positions, such as the greater curvature or anterior wall of the stomach.1,2 However, due to the relative rarity of this tumor, these consensus recommendations are derived from small, retrospective, single institution experiences spanning several years.3,4 No study has characterized the rate of diffusion of MIS for GIST nor the characteristics associated with failure of an MIS approach on a large scale. The aims of this study were to identify national trends in the utilization of MIS and identify risk factors for positive margin.
The National Cancer Database (NCDB) was queried for all patients diagnosed with GIST originating from the stomach (International Classification of Diseases for Oncology, 3rd Edition morphological code 8936, topographical code C16) who underwent resection from 2010 to 2016. Patients were excluded from analysis if they underwent only local tumor destruction/biopsy and had missing information regarding the variables of interest. Rates of completed MIS and open procedures were measured each year. To identify risk factors for positive margin, we performed univariate and multivariate analyses of several variables knowable at the time of surgery. Patients were selected on an intent-to-treat principle, including all those who were intended to undergo MIS (iMIS). Clinical staging information was used for tumor, node, and metastasis classifications based the American Joint Committee on Cancer (AJCC), 7th edition staging for GIST. Binary logistic regression was performed to determine independent predictors of positive margin. Factors included in the model were those with p < 0.1 on bivariate analysis. A two-tailed p value of < 0.05 was considered statistically significant. Statistical analysis was done using SPSS® software version 25.0 (IBM Corporation, Armonk, NY, USA).
Brendan L. Hagerty and Madeline B. Torres contributed equally to this work. * Jeremy L. Davis [email protected] 1
Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Room 4-3760, Bethesda, MD 20892, USA
2
Department of Surgery, The Pennsylvania State University, College
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