Open versus laparoscopic treatment for small bowel gastrointestinal stromal tumors

Gastrointestinal stromal tumors (GISTs) are the most common soft-tissue sarcoma of the gastrointestinal tract. Those found in the small bowel behave more aggressively than tumors originating in the stomach and confer a higher risk of metastases. Minimally invasive resection, including laparoscopic and robotic approaches, has been established as a safe and feasible alternative to conventional open resection for gastric GISTs, with improved perioperative morbidity and non-inferior oncologic outcomes. Data, however, are less established for small bowel tumors. Currently, there are emerging data suggesting that minimally invasive resection is a safe and feasible surgical option with similarly favorable outcomes for small bowel GISTs. Duodenal GISTs, rarer still, are a subset that offer unique anatomic challenges to minimally invasive resection. While minimally invasive approach for duodenal tumors has been described, data remains insufficient to draw clear conclusions on laparoscopic or robotic resection for GISTs located in the duodenum. Caution is merited to avoid overinterpretation of the current limited data. Future research to validate minimally invasive techniques for duodenal lesions is necessary. Regardless of minimally invasive approach, oncologic principles of resection apply. Surgical approach and oncologic planning are dependent on location and size of the tumor, with a range of surgical techniques illustrated in the literature. These techniques and surgical pearls are reviewed to guide technical decision making for these lesions. This narrative review aims to present the latest data on minimally invasive resection for small bowel and duodenal GISTs and discuss surgical considerations.