Minimally invasive surgery for small-bowel gastrointestinal stromal cell tumors over 5 cm: A safe and feasible approach.

Abstract

Surgical resection with negative margins is the standard treatment for resectable gastrointestinal stromal tumors (GISTs). Wide margins and extensive lymphadenectomy are unnecessary, making gastrointestinal stromal tumors strong candidates for minimally invasive surgery. Until recently, National Comprehensive Cancer Network guidelines discouraged minimally invasive surgery for tumors larger than 5 cm; however, previous work has demonstrated its safety for gastric gastrointestinal stromal tumors up to 10 cm. This study evaluates outcomes of minimally invasive surgery for small-bowel gastrointestinal stromal tumors of at least 5 cm. The National Cancer Database was queried from 2010 to 2021 for small-bowel gastrointestinal stromal tumors measuring at least 5 cm that underwent resection. Preoperative demographics, oncologic and postoperative outcomes were analyzed. Multivariate analyses assessed predictors of margin status, hospital length of stay, readmission, and mortality. Cox regression and Kaplan-Meier analyses evaluated survival. Of 4,236 patients, 65.6% underwent open resection and 34.4% had minimally invasive surgery. Preoperative demographics were similar, although tumors were larger in the open cohort (9 vs. 7.5 cm; P < .0001). Open surgery was more common for complex resections (35.3 vs. 23.6%; P < .0001). Median length of stay was shorter after minimally invasive surgery (4 vs 6 days; P < .0001) without differences in margin status, readmissions, or mortality. Use of minimally invasive surgery increased over time (P < .0001) and was more common at comprehensive community hospitals compared with academic centers (44.3 vs. 32.3%; P = .003). On multivariate analyses, minimally invasive surgery reduced the risk for length of stay more than 7 days (odds ratio, 0.61; P < .0001). Overall survival was comparable (hazard ratio, 0.91; P = .2051). For small-bowel gastrointestinal stromal tumors of 5 cm more, minimally invasive surgery is associated with shorter length of stay without compromising patient safety. Increased adoption of minimally invasive surgery highlights the need for concrete guidelines to define its role for gastrointestinal stromal tumors.