Surgical management of gastric gastrointestinal stromal tumors: Comparison of outcomes for open and laparoscopic resection

Objectives Gastrointestinal stromal tumors (GIST) are common mesenchymal tumors of the GI tract, and the stomach is the most common site. Since every GIST is now considered potentially malignant, complete surgical resection is the primary treatment for all GISTs. This study aimed to evaluate the clinical characteristics, diagnosis, therapeutic strategies, and follow-up of patients with primary gastric GISTs in our tertiary care institute. Material and Methods Patients who underwent resection for primary gastric GIST between January 2016 and May 2023 were included. Data on demographics, clinicopathology and surgical parameters were collected. Results A total of 35 patients were included. The mean age was 58 years. Males (62.9%) outnumbered females (37.2%). The tumors varied from 2 to 13 cm in size. The dominant symptom was GI bleeding (20/35), followed by incidental asymptomatic findings (6/35). Of the patients, 12(34.2%) had malena, 8 (22.9%) had hemetemesis, 5 (14.2%) had anemia, 2 (5.7%) had abdominal pain, 1(2.9%) had gastric outlet obstruction, and 1(2.9%) had asymptomatic abdomen mass. Six (17.1%) patients were asymptomatic and diagnosed incidentally. Four (11.5%) patients had a tumour located at the GE junction, 20 (57.1%) at the body of the stomach, and 11(31.4%) had a tumor located at the antrum of the stomach. Five (14.2%) patients had endophytic submucosal lesions, 20 (57.2%) had exophytic, and 10 (28.6%) had both exophytic and endophytic components. Laparoscopic resection was performed on 25 (71.4%) patients and 10 (28.6%) had open surgery. Five (14.3%) were subjected to laparoscopic transgastric excision. There were no oncological differences in open and laparoscopic resection (p-value 0.5). The laparoscopic group had a lower rate of overall complications (0.04% vs. 50%, P= 0.024). The hospital stays and postoperative complications were significantly lower in laparoscopic resection than in open conventional surgery (p value < 0.05). Eleven (31.4%) were categorized into very low risk, 15 (42.9%) low risk, 6 (17.1%) intermediate risk, and 3 (8.6%) had high-risk tumors. Six (17.1%) patients were subjected to adjuvant imatinib therapy. None of our patients had recurrence during follow up and there was no mortality. Conclusion Laparoscopic resection for gastric GISTs is associated with lower complications and improved surgical and oncological outcomes. Laparoscopic transgastric resection emerges as a promising technique for the treatment of GISTs near the GE junction, as it allows direct visualization of the lesion and better control of the surgical margins.