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META ANALYSIS
Year : 2017  |  Volume : 130  |  Issue : 13  |  Page : 1595-1603

Laparoscopic Versus Open Resection of Small Bowel Gastrointestinal Stromal Tumors: Systematic Review and Meta-Analysis


1 Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016; School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310058, China
2 School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310058, China
3 Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, China

Correspondence Address:
Xiu-Jun Cai
Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang 310016, China School of Medicine, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang 310058,
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0366-6999.208249

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Background: Laparoscopic resection (LAP) for small bowel gastrointestinal stromal tumors (GISTs) is not as common as for stomach. This study aimed to evaluate the safety and efficacy of LAP for small bowel GISTs with systematic review and meta-analysis. Methods: The Web of Science, Cochrane Library, Embase, and PubMed databases before December 2016 were comprehensively searched to retrieve comparative trials of LAP and conventional open resection (OPEN) for GISTs of small bowel with a relevance of review object. These researches reported intraoperative and postoperative clinical course (operation time, blood loss, time to first flatus and oral intake, hospital stay, morbidity, and mortality), oncologic outcomes, and long-term survival status. Results: Six studies involving 391 patients were identified. Compared to OPEN, LAP had associated with a shorter operation time (weighted mean difference [WMD] = −27.97 min, 95% confidence interval [CI]: −49.40–−6.54, P < 0.01); less intraoperative blood loss (WMD = −0.72 ml; 95% CI: −1.30–−0.13, P = 0.02); earlier time to flatus (WMD = −0.83 day; 95% CI: −1.44–−0.22, P < 0.01); earlier time to restart oral intake (WMD = −1.95 days; 95% CI: −3.31–−0.60, P < 0.01); shorter hospital stay (WMD = −3.00 days; 95% CI: −4.87–−1.13, P < 0.01); and a decrease in overall complications (risk ratio = 0.56, 95% CI: 0.33–0.97, P = 0.04). In addition, the tumor recurrence and long-term survival rate showed that there was no significant difference between the two groups of patients. Conclusions: LAP for small bowel GISTs is a safe and feasible procedure with shorter operation time, less blood loss, less overall complications, and quicker recovery. Besides, tumor recurrence and the long-term survival rate are similar to open approach. Because of the limitations of this study, methodologically high-quality studies are needed for certain appraisal.


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