Abstract
BackgroundEndoscopic resection (ESR) is a novel minimally invasive procedure for superficial tumors. Its safety, efficiency, and outcome for gastric gastrointestinal stromal tumors (gGISTs) less than 5 cm remains unclear compared to laparoscopic resection (LAR) and open resection (ONR). The current network meta-analysis aimed to review and analyze the available evidence of this question.MethodsPubMed, Embase, Cochrane Library, and Web of Science databases were searched to identify eligible studies published up to July 6, 2020. The perioperative and long-term oncological outcomes among ESR, LAR, and ONR for gGIST (<5 cm) were estimated through the Bayesian network meta-analysis with a random-effect model.ResultsFifteen studies with 1,631 patients were included. ESR was associated with a shorter operative time [mean difference, MD: -36; 95% confidence interval, CI (-55, -16)], a higher rate of positive margin [odds ratio, OR: 5.1 × 1010, 95% CI (33, 2.5 × 1032)], and less costs [MD: -1 × 104, 95% CI (-1.6 × 104, -4.4 × 103)] but similar time to resume flatus [MD: 0.52, 95% CI (-0.16, 1.1)] and diet [MD: -3.5, 95% CI (-5.6, -1.6)] compared to LAR. A higher rate of total complications [OR: 11, 95% CI (1.2, 140)] was observed in patients who received ESR compared to patients who received LAR. After excluding perforation from the total complication category, the difference of complication between ESR and LAR disappeared [OR: 0.87, 95% CI (0.22, 2.3)]. The recurrence rate [OR: 1.3, 95% CI (0.40, 4.5)] and disease-free survival [hazard ratio: 1.26, 95% CI (0.60, 2.63)] showed no significant difference between ESR and LAR. ESR was associated with better or equivalent perioperative and long-term outcomes compared to ONR, except for positive margin. A subgroup analysis (<2 and 2–5 cm) showed no significantly different results among these three procedures either.ConclusionESR was shown to be a safe and efficient alternative procedure to both LAR and ONR for gGISTs less than 2 cm and within 2–5 cm, respectively, without worsening the oncologic outcomes. However, preoperative assessment of tumor site is of importance for the determination of procedures regarding the increased incidence of a positive margin related to ESR.
Highlights
Gastrointestinal stromal tumor (GIST), one of the most common mesenchymal tumors arising from the digestive tract, has the highest incidence in stomach [1]
Endoscopic resection (ESR), with the superiority of maintaining the intact structure of the stomach, has been demonstrated safe and effective for gastric GIST (gGIST) not larger than 5 cm when performed by an experienced endoscopists [6], but it is challenging for endoscopic resection (ESR) to ensure R0 resection, and its specific complications, such as perforation and bleeding, may result in conversion to surgery [7]
The results were screened and identified by two authors (ZL and SO) according to the following criteria: [1] studies that compared any two or three of ESR, Laparoscopic resection (LAR), and open resection (ONR) for patients with gGIST, [2] studies that included patients whose tumor diameter was less than 5 cm, [3] studies that included arms that had more than 10 cases of patients, [4] studies that provided perioperative outcomes and/or long-term survival outcomes, and [5] when duplicate studies based on similar populations were identified, only the newest or largest study was included
Summary
Gastrointestinal stromal tumor (GIST), one of the most common mesenchymal tumors arising from the digestive tract, has the highest incidence in stomach [1]. Some studies reported that LAR was even safe and feasible for gGIST larger than 5 cm compared with open resection (ONR). Endoscopic resection (ESR), with the superiority of maintaining the intact structure of the stomach, has been demonstrated safe and effective for gGIST not larger than 5 cm when performed by an experienced endoscopists [6], but it is challenging for ESR to ensure R0 resection, and its specific complications, such as perforation and bleeding, may result in conversion to surgery [7]. Efficiency, and outcome for gastric gastrointestinal stromal tumors (gGISTs) less than 5 cm remains unclear compared to laparoscopic resection (LAR) and open resection (ONR). The current network meta-analysis aimed to review and analyze the available evidence of this question
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
