The impact of postoperative and oncologic outcomes between laparoscopic (L) and open (O) surgical approaches for the resection of gastric gastrointestinal stromal tumors (G-GISTs) located in surgically unfavorable regions remains controversial.

A retrospective analysis was conducted on 699 patients who underwent primary resection of G-GISTs at surgically unfavorable locations across 14 centers in China between 2001 and 2017. The patients were categorized into L and O surgery groups. To reduce bias due to baseline differences, propensity score matching (PSM) and multivariate Cox proportional hazards models were employed. Postoperative recovery metrics and long-term oncologic outcomes were compared between the matched cohorts.

After 1:1 PSM, the L group exhibited a significantly shorter and lower postoperative hospital stay, intraoperative estimated blood loss and postoperative complication rate compared to the O group (all P < .010). Kaplan–Meier survival analysis with log-rank testing revealed no statistically significant differences in overall survival (OS) between the two groups (P = .190). Multivariate Cox proportional hazards analysis further indicated that the L approach was not associated with a significant reduction in mortality risk (hazard ratio [HR]: 1.41; 95% confidence interval [CI]: 0.56–3.60; P = .467).

Laparoscopic resection of G-GISTs located at surgically unfavorable sites was associated with improved short-term postoperative outcomes, including reduced blood loss, shorter hospital stays and fewer complications, compared to open surgery, but had comparable long-term oncologic outcomes.