Comparison of laparoscopic versus open approach surgery for gastric gastrointestinal stromal tumors in unfavorable surgical locations

The impact of postoperative and oncologic outcomes between laparoscopic (L) and open (O) surgical approaches for the resection of gastric gastrointestinal stromal tumors (G-GISTs) located in surgically unfavorable regions remains controversial. A retrospective analysis was conducted on 699 patients who underwent primary resection of G-GISTs at surgically unfavorable locations across 14 centers in China between 2001 and 2017. The patients were categorized into L and O surgery groups. To reduce bias due to baseline differences, propensity score matching (PSM) and multivariate Cox proportional hazards models were employed. Postoperative recovery metrics and long-term oncologic outcomes were compared between the matched cohorts. After 1:1 PSM, the L group exhibited a significantly shorter and lower postoperative hospital stay, intraoperative estimated blood loss and postoperative complication rate compared to the O group (all P < .010). Kaplan–Meier survival analysis with log-rank testing revealed no statistically significant differences in overall survival (OS) between the two groups (P = .190). Multivariate Cox proportional hazards analysis further indicated that the L approach was not associated with a significant reduction in mortality risk (hazard ratio HR: 1.41; 95% confidence interval CI: 0.56–3.60; P = .467). Laparoscopic resection of G-GISTs located at surgically unfavorable sites was associated with improved short-term postoperative outcomes, including reduced blood loss, shorter hospital stays and fewer complications, compared to open surgery, but had comparable long-term oncologic outcomes.