Maximizing how minimal we can go: a narrative review of minimally invasive surgery for gastric gastrointestinal stromal tumors

Abstract

Background and Objective: Minimally invasive surgery (MIS) has been adopted for resection of many gastrointestinal cancers, such as gastrointestinal stromal tumors (GISTs). Gastric GISTs, especially those favorable in size and anatomic location, are increasingly resected through MIS procedures. However open resections remain common for tumors deemed more difficult secondary to size or location. We present a narrative review of the available literature on safety, feasibility and oncologic outcomes for MIS resections compared to open surgery for tumors ≤5 cm, >5 cm, and in unfavorable anatomic locations. We also explore laparoscopic and endoscopic cooperative surgical techniques, which evolved in parallel to laparoscopic and robotic surgery. Methods: A search was conducted in PubMed, Medline, and Cochrane Review databases to identify retrospective and prospective studies comparing outcomes of minimally invasive vs. open resections from 2006 to 2023. The search utilized the phrases “minimally invasive”, “laparoscopic surgery”, “robotic surgery”, “endoscopy”, “laparoscopic-endoscopic cooperative surgery”, “gastrointestinal stromal tumors”, “GIST”. Key Content and Findings: For gastric GISTs ≤5 cm and in anatomically favorable locations, current data support MIS resections given similar oncologic outcomes compared to open approaches. For gastric GISTs >5 cm, MIS resections may take longer than open surgery, but have similar postoperative and oncologic outcomes. These findings are similar to those for tumors located in anatomically unfavorable areas. There is also emerging evidence that laparoscopic and endoscopic cooperative surgery (LECS) is safe and feasible compared to traditional MIS approaches, primarily in GISTs ≤5 cm. Conclusions: MIS resection of selected gastric GISTs appears to be a safe and feasible approach compared to conventional open resection. Current data would benefit from the addition of prospective data and clinical trials, but may be difficult due to the rarity of this tumor.