Minimally Invasive Approach to Gastric GISTs: Analysis of a Multicenter Robotic and Laparoscopic Experience with Literature Review
by
, , , ,
Graziano Ceccarelli
1,2,3, 
Gianluca Costa
1,2,4
,
Michele De Rosa
5,
Massimo Codacci Pisanelli
6,
Barbara Frezza
3,
Marco De Prizio
3,
Ilaria Bravi
7,
Andrea Scacchi
8,
Gaetano Gallo
9,10
,
Bruno Amato
11,
Walter Bugiantella
1,2,†,
Piergiorgio Tacchi
1,2,†,
Alberto Bartoli
1,2,†,
Alberto Patriti
1,2,12,†,
Micaela Cappuccio
8,†,
Klara Komici
8,†,
Lorenzo Mariani
1,2,†,
Pasquale Avella
8 and
Aldo Rocca
3,8,* 1
General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, 06034 Foligno, Italy
2
General, Minimally Invasive and Robotic Surgery, Department of Surgery, ASL 2 Umbria, San Matteo Hospital, 06049 Spoleto, Italy
3
General Surgery Unit, San Donato Hospital, 52100 Arezzo, Italy
4
Surgery Center, University Campus Bio-Medico of Rome, 00128 Rome, Italy
5
Department of General Surgery, San Giovanni Battista Hospital, 06034 Perugia, Italy
6
UOC General Surgery and Laparoscopic Surgery, Department of Surgery P. Valdoni, Policlinic Umberto I, Sapienza University of Study of Rome, 00161 Rome, Italy
7
Histopathology Department, Usl Umbria 2, San Giovanni Battista Hospital, 06034 Foligno, Italy
8
Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy
9
Department of Medical and Surgical Sciences, University of Catanzaro, 88100 Catanzaro, Italy
10
Department of Colorectal Surgery, S. Rita Clinic, 13100 Vercelli, Italy
11
Department of Clinical Medicine and Surgery, University of Naples Federico II, 80126 Naples, Italy
12
Division of General Surgery, Ospedali Riuniti Marche Nord, 61121 Pesaro, Italy
*
Author to whom correspondence should be addressed.
†
There authors are from Gastric GIST Collaborative Group.
Cancers 2021, 13(17), 4351; https://doi.org/10.3390/cancers13174351
Submission received: 28 June 2021
/
Revised: 4 August 2021
/
Accepted: 24 August 2021
/
Published: 27 August 2021
(This article belongs to the Special Issue New Technologies and Advancements in Gastro-Esophageal Cancer Surgery)
Simple Summary
Gastrointestinal stromal tumors (GISTs) represent about 1–3% of all gastrointestinal malignancies, of which 50–60% are gastric GISTs (GGs). To the date, surgery represents the best therapeutic option, and the robotic gastric surgery could gain an important role, overcoming many laparoscopic drawbacks. The aim of this study is to evaluate safety and effectiveness of minimally invasive surgery (MIS) for GGs, reporting 10-year experience of three different centers. We included a population of 81 patients who underwent MIS approaches (36 laparoscopy vs. 45 robotic surgery). Seventy-two (72) patients were enrolled in a follow-up program to evaluate the long-term oncological outcomes. Furthermore, we discussed some technical notes and also we analyzed the operative and peri-operative outcomes. In conclusion, our results suggest that the robotic approach might be a suitable treatment, especially for GISTs >5 cm, even located in unfavorable places, despite longer operative time and costs than laparoscopic approach.
Abstract
Background: Gastrointestinal stromal tumors (GISTs) are most frequently located in the stomach. In the setting of a multidisciplinary approach, surgery represents the best therapeutic option, consisting mainly in a wedge gastric resection. (1) Materials and methods: Between January 2010 to September 2020, 105 patients with a primary gastrointestinal stromal tumor (GISTs) located in the stomach, underwent surgery at three surgical units. (2) Results: A multi-institutional analysis of minimally invasive series including 81 cases (36 laparoscopic and 45 robotic) from 3 referral centers was performed. Males were 35 (43.2%), the average age was 66.64 years old. ASA score ≥3 was 6 (13.3%) in the RS and 4 (11.1%) in the LS and the average tumor size was 4.4 cm. Most of the procedures were wedge resections (N = 76; 93.8%) and the main operative time was 151 min in the RS and 97 min in the LS. Conversion was necessary in five cases (6.2%). (3) Conclusions: Minimal invasive approaches for gastric GISTs performed in selected patients and experienced centers are safe. A robotic approach represents a useful option, especially for GISTs that are more than 5 cm, even located in unfavorable places.
