(P 106) LAPAROSCOPY IN GASTRIC GIST: RETROSPECTIVE PRE-POST COMPARISON ANALYSIS OF SHORT TERM OUTCOMES ON A CONSECUTIVE SERIES OF 95 CASES FROM A TERTIARY REFERRAL CENTRE

Objective: To revise the short term outcomes in the management of patients diagnosed with gastric GIST since a shift towards a less invasive surgical approach has been introduced in our surgical unit in a sarcoma referral centre.

Methods: Data of patients underwent surgery for gastric GIST between 2000 and 2022 were retrospectively reviewed from our prospectively maintained database. The sample was split in two groups according to the introduction of a less-invasive surgical approach in 2017. Characteristics of patients, tumour, type of surgery and postoperative course were compared between the two groups.

Results: Between January 2000 and February 2022, 95 patients underwent surgery for gastric GIST in our surgical department: 59 in the period 2000-2016 (early group) and 36 in the period 2017-2022 (late group). In the early group, 59 patients (93.22%) underwent open surgery and 4 patients (6.78%) underwent laparoscopic procedures; in the late group 22 patients (61.11%) were treated with minimally invasive surgery and 14 (38.89%) received traditional surgery.
The median diameter was 44 mm (range 3-250) and 48 mm (range 17-160) in the early and in the late group, respectively. Considering only patients underwent minimally invasive surgery, in the early group median diameter was 41.5 mm (range 6-80) and in the late group median diameter was 45.5 mm (range 17-90).
Median postoperative stay was 7 days in both groups, ranging between 4 and 47 days in the early group and between 5 and 65 days in the late group.
Sixteen patients (27.12%) in the early group and 8 patients (22.22%) in the late group experienced complications; severe complications (Clavien-Dindo>3) occurred in 4 patients (6.78%) in the early group; no major complications occurred in the late group. Mortality was observed in 1 patient (1.69%) in the early group and in 1 patient (2.78%) in the late group; both patients underwent open surgery. Concerning Imatinib in the preoperative setting, 9 patients (15.25%) in the early group and 9 patients (25%) in the late group received neoadjuvant therapy. Results of subgroups of patients according on the operative technique are shown in Table 1.

Conclusion: The approach towards gastric GIST in our surgical department has changed in recent years, as we are now more prone to treat GIST with a minimally invasive technique. In our experience, laparoscopic surgery for gastric GIST resulted in no severe complications and no mortality. The increase in the median diameter of tumours in both open and laparoscopic group in the late period may reflect an increasing experience of surgeons in minimally invasive approaches, as well as a careful section of patients who are better candidates for open surgery.