Laparoscopic versus open surgery for locally advanced gastric gastrointestinal stromal tumors following neoadjuvant imatinib therapy: a multicenter propensity-weighted cohort study.

BACKGROUND

Neoadjuvant imatinib therapy (NIT) is the standard of care for gastric locally advanced gastrointestinal stromal tumors (LA-GIST), yet the optimal surgical approach following treatment remains undefined. This multicenter study compared the safety and long-term efficacy of laparoscopic surgery versus open surgery in this patient population.

METHODS

We retrospectively analyzed 76 patients from four Chinese centers using inverse probability weighting (IPW) to balance baseline covariates. Primary endpoints were 5-year disease-free survival (DFS) and overall survival (OS); secondary endpoints included perioperative outcomes and complications.

RESULTS

After IPW adjustment, the laparoscopic (n = 42) and open surgery (n = 34) groups were well-balanced. Laparoscopic surgery was associated with significantly reduced intraoperative blood loss, lower intraoperative transfusion rates, and shorter postoperative hospital stays. No significant differences were found in operative time, R0 resection rates, or complications. In exploratory subgroup analyses, the reduction in intraoperative blood loss associated with laparoscopic surgery did not reach statistical significance in patients aged ≥60 years, those with tumors ≥10 cm, or those undergoing combined organ resection, and no statistically significant interactions were detected between surgical approach and these factors. In terms of long-term outcomes, no statistically significant differences were observed in 5-year DFS (HR = 0.73, P = 0.499) or 5-year OS (HR = 0.86, P = 0.842) between the two approaches.

CONCLUSIONS

Laparoscopic surgery for gastric LA-GIST following NIT was associated with improved perioperative outcomes and showed no statistically significant differences in long-term survival compared with open surgery. In complex cases, including elderly patients, patients with large tumors, or those requiring combined organ resection, surgical decision-making should remain individualized.