J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Review

Volume 7, Number 5, May 2015, pages 289-296

A Systematic Review and Meta-Analysis of Open vs. Laparoscopic Resection of Gastric Gastrointestinal Stromal Tumors

Figure 2. Forest plot depicting the mean differences in length of hospital stay (days) in the included studies, if reported.

Figure 3. Forest plot depicting the mean differences in length of operative time (min) in the included studies, if reported.

Figure 4. Forest plot depicting the risk ratio of total adverse events in the included studies, if reported.

Figure 5. Forest plot depicting the mean differences in the estimated blood loss (mL) in the included studies, if reported.

Figure 7. Forest plot depicting the risk ratio for overall survival in the included studies, if reported.

**Table 1.** Medline Search Strategy
Concept 1		Concept 2		Concept 3		Concept 4	Results
Limit to English language.
laparoscop* or exp laparoscopy or telesurg* or “tele surg” or minimal adj3 (invasiv* or access) or celiosc	AND	(usual or wedge or traditional or standard* or open or invasive or normal or routine) adj3 (resect* or surger* or surgi*)	AND	GIST or exp gastrointestinal stromal tumors/or (gastrointestinal stromal adj2 (neoplasm* or tumo*)).mp.	AND	gastri* or stomach	81

Table 1. Medline Search Strategy

Concept 1

Concept 2

Concept 3

Concept 4

Results

Limit to English language.

laparoscop* or exp laparoscopy or telesurg* or “tele surg*” or minimal*
adj3 (invasiv* or access*) or celiosc*

AND

(usual or wedge or traditional or standard* or open or invasive or normal or routine) adj3 (resect* or surger* or surgi*)

AND

GIST or exp gastrointestinal stromal tumors/or (gastrointestinal stromal adj2 (neoplasm* or tumo*)).mp.

AND

gastri* or stomach

**Table 2.** Study Characteristics
Authors	Year	Journal name	Article name	Design	Outcomes	Follow-up period (months)
RCS: retrospective cohort study; CCS: case-control study; BMI: body mass index; LOS: length of stay; OR time: operating room time; EBL: estimated blood loss; Med: median; N/A: not available; L: laparoscopic group; O: open group.
Catena et al	2008 [1]	Journal of Gastrointestinal Surgery	Laparoscopic treatment of gastric GIST: report of 21 cases and literature’s review	RCS	LOS OR time Adverse events Conversion rate Overall survival EBL Recurrence rate	Mean: 35	Mean: 91
Nishimura et al	2007 [3]	Surgical Endoscopy	Surgical strategy for gastric gastrointestinal stromal tumors: laparoscopic vs. open resection	RCS	OR time Conversion rate EBL Recurrence rate	Median: 19	Median: 31
Karakousis et al	2011 [10]	Annals of Surgical Oncology	Laparoscopic versus open gastric resections for primary gastrointestinal stromal tumors (GISTs): a size-matched comparison	CCS	LOS OR time Adverse events Overall survival EBL Recurrence rate	Median: 28	Median: 43
Matthews et al	2002 [11]	Surgical Endoscopy	Laparoscopic vs. open resection of gastric stromal tumors	RCS	LOS OR time Adverse events EBL Recurrence rate	Mean: 20	Mean: 18
Pitsinis et al	2007 [12]	Hepato-Gastroenterology	Single center experience of laparoscopic vs. open resection for gastrointestinal stromal tumors of the stomach	RCS	LOS OR time Adverse events Recurrence rate	Median: 9	Median: 9
Silberhumer et al	2009 [13]	Journal of Gastrointestinal Surgery	Surgery for gastrointestinal stromal tumors of the stomach	RCS	LOS Adverse events Conversion rate Recurrence rate	Mean: 30	Mean: 41
Wu et al	2010 [14]	Journal of Laparoscopic and Advanced Surgical Techniques	Gasless laparoscopy-assisted versus open resection for gastrointestinal stromal tumors of the upper stomach: preliminary results	RCS	LOS OR time Adverse events Pain score Conversion rate Overall survival EBL	N/A	N/A

Table 2. Study Characteristics

Authors

Year

Journal name

Article name

Design

Outcomes

Follow-up period (months)

RCS: retrospective cohort study; CCS: case-control study; BMI: body mass index; LOS: length of stay; OR time: operating room time; EBL: estimated blood loss; Med: median; N/A: not available; L: laparoscopic group; O: open group.

Catena et al

2008 [1]

Journal of Gastrointestinal Surgery

Laparoscopic treatment of gastric GIST: report of 21 cases and literature’s review

RCS

LOS
OR time
Adverse events
Conversion rate
Overall survival EBL
Recurrence rate

Mean: 35

Mean: 91

Nishimura et al

2007 [3]

Surgical Endoscopy

Surgical strategy for gastric gastrointestinal stromal tumors: laparoscopic vs. open resection

RCS

OR time
Conversion rate EBL
Recurrence rate

Median: 19

Median: 31

Karakousis et al

2011 [10]

Annals of Surgical Oncology

Laparoscopic versus open gastric resections for primary gastrointestinal stromal tumors (GISTs): a size-matched comparison

CCS

LOS
OR time
Adverse events Overall survival EBL
Recurrence rate

Median: 28

Median: 43

Matthews et al

2002 [11]

Surgical Endoscopy

Laparoscopic vs. open resection of gastric stromal tumors

RCS

LOS
OR time
Adverse events
EBL
Recurrence rate

Mean: 20

Mean: 18

Pitsinis et al

2007 [12]

Hepato-Gastroenterology

Single center experience of laparoscopic vs. open resection for gastrointestinal stromal tumors of the stomach

RCS

LOS
OR time
Adverse events
Recurrence rate

Median: 9

Silberhumer et al

2009 [13]

Journal of Gastrointestinal Surgery

Surgery for gastrointestinal stromal tumors of the stomach

RCS

LOS
Adverse events
Conversion rate
Recurrence rate

Mean: 30

Mean: 41

Wu et al

2010 [14]

Journal of Laparoscopic and Advanced Surgical Techniques

Gasless laparoscopy-assisted versus open resection for gastrointestinal stromal tumors of the upper stomach: preliminary results

RCS

LOS
OR time
Adverse events
Pain score
Conversion rate
Overall survival
EBL

N/A

**Table 3.** Patient Characteristics of Included Trials
Authors, year	Number of patients	Age	BMI	Tumor size	Procedures performed
Values expressed as mean unless otherwise indicated. ^t: median value. L: laparoscopic group; O: open group; N/A: not available; W: wedge resection; DG: distal gastrectomy; PG: proximal gastrectomy; TG: total gastrectomy.
Catena et al, 2008 [1]	21	25	50.1	54.6	N/A	N/A	4.5	6.2	86% W; 14% DG	50% W; 33% DG; 17% PG
Nishimura et al, 2007 [3]	39	28	62^t	63^t	N/A	N/A	3.8^t	4.2^t	100% W	68% W; 4% DG; 18% PG; 11% TG
Karakousis et al, 2011 [10]	40	40	67^t	70^t	N/A	N/A	3.6^t	4.3^t	100% W	95% W; 5% DG
Matthews et al, 2002 [11]	21	12	53.9	50.5	N/A	N/A	4.5	4.9	86% W; 14% DG	50% W; 33% DG; 17% PG
Pitsinis et al, 2007 [12]	6	7	70^t	68^t	N/A	N/A	5^t	11.5^t	N/A	N/A
Silberhumer et al, 2009 [13]	22	41	61.3	62.5	N/A	N/A	3.5	5.8	100% W	78% W; 12% DG; 10% TG
Wu et al, 2010[14]	15	13	61.6	60.7	23.4	22.7	2.6	2.5	100% W	100% W

Table 3. Patient Characteristics of Included Trials

Authors, year

Number of patients

Age

BMI

Tumor size

Procedures performed

Values expressed as mean unless otherwise indicated. ^t: median value. L: laparoscopic group; O: open group; N/A: not available; W: wedge resection; DG: distal gastrectomy; PG: proximal gastrectomy; TG: total gastrectomy.

Catena et al, 2008 [1]

50.1

54.6

N/A

4.5

6.2

86% W; 14% DG

50% W; 33% DG; 17% PG

Nishimura et al, 2007 [3]

62^t

63^t

N/A

3.8^t

4.2^t

100% W

68% W; 4% DG; 18% PG; 11% TG

Karakousis et al, 2011 [10]

67^t

70^t

N/A

3.6^t

4.3^t

100% W

95% W; 5% DG

Matthews et al, 2002 [11]

53.9

50.5

N/A

4.5

4.9

86% W; 14% DG

50% W; 33% DG; 17% PG

Pitsinis et al, 2007 [12]

70^t

68^t

N/A

5^t

11.5^t

N/A

Silberhumer et al, 2009 [13]

61.3

62.5

N/A

3.5

5.8

100% W

78% W; 12% DG; 10% TG

Wu et al, 2010[14]

61.6

60.7

23.4

22.7

2.6

2.5

100% W

**Table 4.** Newcastle-Ottawa Scale for Risk of Bias
Study ID	Catena et al, 2008 [1]	Nishimura et al, 2007 [3]	Karakousis et al, 2011 [10]	Matthews et al, 2002 [11]	Pitisinis et al, 2007 [12]	Silberhumer et al, 2009 [13]	Wu et al, 2012 [14]
Study design	Retrospective cohort	Retrospective cohort	Case-control study	Retrospective cohort	Retrospective cohort	Retrospective cohort	Retrospective cohort
Selection	****	****	****	****	****	****	****
Comparability			*
Outcome/exposure	***	***	***	***	***	***	***

Table 4. Newcastle-Ottawa Scale for Risk of Bias

Study ID

Catena et al, 2008 [1]

Nishimura et al, 2007 [3]

Karakousis et al, 2011 [10]

Matthews et al, 2002 [11]

Pitisinis et al, 2007 [12]

Silberhumer et al, 2009 [13]

Wu et al, 2012 [14]

Study design

Retrospective cohort

Case-control study

Retrospective cohort

Selection

****

Comparability

Outcome/exposure

***