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A Systematic Review and Meta-Analysis Comparing Laparoscopic Versus Open Gastric Resections for Gastrointestinal Stromal Tumors of the Stomach |
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| Authors: | Ye-Xin Koh MBBS MRCS Aik-Yong Chok MBBS MRCS Hui-Li Zheng BSc Chuen-Seng Tan BSc MSc PhD Pierce K H Chow MBBS FRCS PhD Wai-Keong Wong MBBS FRCS Brian K P Goh MBBS MMed MSc FRCS |
| Institution: | 1. Department of Surgery, Singapore General Hospital, Singapore, Singapore 2. Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore 3. Duke-NUS Graduate Medical School, Singapore, Singapore |
| Abstract: | BackgroundThis 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).MethodsComparative studies reporting the outcomes of LR and OR for GIST were reviewed.ResultsA 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).ConclusionsLR results in superior short-term postoperative outcomes without compromising oncological safety and long-term oncological outcomes compared with OR. |
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