Introduction: Gastrointestinal stromal tumors (GISTs) frequently present as a large exophytically growing mass in the stomach, for which open partial gastrectomy is standard of care. The aim of this study was to evaluate the safety and feasibility of minimally invasive gastric resection (MIG) of large (>5 cm) GIST. Methods: All patients who underwent MIG for a GIST in the University Medical Center Utrecht between 2011 and 2019 were included. Postoperative course and oncological outcomes were analyzed. Results: Twenty-two patients with gastric GIST, median size 53 mm [20–175 mm], underwent MIG. In 4 patients, preoperative imatinib was given, aiming for tumor regression. Conversion from laparoscopic to open surgery occurred once (5%). An additional resection was performed in 3 patients (14%). In 2 patients (9%), an intraoperative complication occurred, consisting of tumor rupture in 1 patient (5%), and 6 patients (27%) developed postoperative complications. Median hospital stay was 5 days [3–7 days]. R0 resection was achieved in 96%. In 4 patients, adjuvant treatment was indicated. The median follow-up was 31 months, and 1-, 3- and 5-year disease-free survival were 94, 74 and 74%, respectively. One patient presented with local recurrence 2 years after the index resection. Conclusion: MIG for large GIST up to 17.5 cm in diameter is safe, feasible, and oncologically sound, allowing for a controlled resection and reduced patient morbidity.

中文翻译：

---

大型胃胃肠道间质瘤的微创切除术

简介：胃肠道间质瘤 (GIST) 经常表现为胃中巨大的外生性生长肿块，因此开放部分胃切除术是标准治疗方法。本研究的目的是评估微创胃切除术 (MIG) 对大 (>5 cm) GIST 的安全性和可行性。方法：纳入了 2011 年至 2019 年在乌得勒支大学医学中心接受 MIG 治疗 GIST 的所有患者。分析术后病程和肿瘤学结果。结果：22 名胃 GIST 患者，中位大小 53 mm [20-175 mm]，接受了 MIG。4 例患者术前给予伊马替尼，目的是肿瘤消退。从腹腔镜手术转换为开腹手术曾经发生过一次 (5%)。3 名患者 (14%) 进行了额外切除。在 2 名患者 (9%) 中，发生了术中并发症，包括 1 名患者 (5%) 的肿瘤破裂，6 名患者 (27%) 出现术后并发症。中位住院时间为 5 天 [3-7 天]。R0 切除率达到 96%。4 例患者需要辅助治疗。中位随访时间为 31 个月，1 年、3 年和 5 年无病生存率分别为 94%、74% 和 74%。一名患者在索引切除后 2 年出现局部复发。结论：对于直径达 17.5 cm 的大 GIST，MIG 是安全、可行且在肿瘤学上合理的，允许受控切除并降低患者发病率。指示辅助治疗。中位随访时间为 31 个月，1 年、3 年和 5 年无病生存率分别为 94%、74% 和 74%。一名患者在索引切除后 2 年出现局部复发。结论：对于直径达 17.5 cm 的大 GIST，MIG 是安全、可行且在肿瘤学上合理的，允许受控切除并降低患者发病率。指示辅助治疗。中位随访时间为 31 个月，1 年、3 年和 5 年无病生存率分别为 94%、74% 和 74%。一名患者在索引切除后 2 年出现局部复发。结论：对于直径达 17.5 cm 的大 GIST，MIG 是安全、可行且在肿瘤学上合理的，允许受控切除并降低患者发病率。