Laparoscopic versus open wedge resection for gastrointestinal stromal tumors of the stomach: a meta-analysis

Introduction
With the rapid development of minimally invasive surgery, laparoscopic (LAP) wedge resection has become the first-choice treatment for primary gastrointestinal stromal tumors (GISTs) of the stomach.

Aim
To investigate the safety and feasibility of LAP wedge resection and the choice of surgical treatment for GISTs of the stomach through a meta-analysis and systematic review.

Material and methods
The literature was widely searched for comparative studies on open (OPEN) and LAP wedge resection for GISTs published before April 2017. The articles were selected after quality assessment.

Results
Ten reports met the inclusion criteria, with a total sample size of 485 cases. The operation time was similar between the 2 groups (weighted mean difference (WMD): 8.67 min, 95% confidence interval (CI): –8.60 to 25.94, p = 0.33). However, LAP resulted in less blood loss (WMD –32.20 ml, 95% CI: –56.15 to –8.26, p < 0.01), earlier time to flatus (WMD –1.48 days, 95% CI: –1.90 to –1.06, p < 0.01) and to an oral diet (WMD –1.50 days, 95% CI: –2.25 to –0.47, p < 0.01), shorter hospital stay (WMD –2.03 days, 95% CI: –2.68 to –1.38, p < 0.01), and a decreased overall complication rate (relative risk: 0.48, 95% CI: 0.25–0.89, p = 0.01) compared with OPEN. Moreover, long-term follow-up findings indicated no obvious difference between the 2 groups.

Conclusions
The use of LAP wedge resection for suitable cases is safe and feasible because it causes less blood loss and fewer overall complications and enables faster recovery.