Minimally invasive transgastric resection of gastric GIST is a feasbile alternative to wedge resection.

BACKGROUND

Surgical resection remains the primary treatment for gastrointestinal stromal tumors (GIST) arising from the stomach. Many tumors are amenable to stapled wedge resection (WR); however, large tumors or those arising in anatomically challenging locations may necessitate formal gastrectomy. Transgastric resection (TGR)-tumor excision via gastrotomy-has been proposed as a tissue-sparing alternative to WR. No large series have directly compared minimally invasive TGR and WR.

STUDY

DESIGN

We performed a single-center retrospective cohort study of adults who underwent minimally invasive GIST resection between 2019 and 2025 at an academic medical center. The primary outcome was R0 resection. Secondary outcomes included recurrence, complication rates, readmission, operative time, and estimated blood loss (EBL). Outcomes were compared using Fisher's Exact testing, independent t-testing, or log-rank testing as appropriate.

RESULTS

Among 433 gastric resections, 92 involved minimally invasive resection of a gastric GIST: (30 TGR; 62 WR). Demographics and comorbidities and mean tumor size were similar. TGR was used more frequently for surgically high-risk GIST tumors (defined as proximal to the GEJ or the pylorus or > 5 cm by preoperative endoscopy). Operative metrics were comparable with anticipated slightly increased operative time in TGR (125.2 vs. 97.9, p 0.05) Postoperative outcomes were similar, with no difference in complication rates (6.3% vs. 1.6%, p 0.27) and readmission (3.3% vs. 3.1%, p 0.99). We found no difference in R0 resection (96.7% vs. 88.7%, p 0.26).

CONCLUSION

Minimally invasive TGR offers a feasible alternative WR for management of gastric GISTs. TGR may offer tissue-sparing resection when WR is technically challenging, and formal gastrectomy might otherwise be required.