Endoscopic Submucosal Dissection vs. Surgical Resection of Gastrointestinal Stromal Tumors in North America

Abstract

Introduction: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. The primary method of resecting these neoplasms is via laparoscopic or open surgery. Surgical procedures are associated with high cost, morbidity and mortality. In recent years, less invasive procedures such as endoscopic submucosal dissection (ESD) have been used to resect GISTs. The aim of this retrospective study is to investigate the clinical efficacy, safety, and feasibility of endoscopic vs surgical interventions in resection of GISTs. Methods: This was a single center retrospective study in which we compared the data of patients with GISTs who had undergone endoscopic (endoscopic group) versus surgical (control group) resection from 2014 to 2016. Only gastric tumors up to 5 cm in size were included in the study. Surveillance was performed with CT abdomen, EGD or close oncology follow-up at 3-12 month intervals. Main outcome measures were recurrence rate, operative time, postoperative complications, hospital stays, and analgesic requirement. Results: Out of 14 patients in the endoscopic group, 12 met our criteria. Endoscopic enucleation was performed for endophytic lesions and endoscopic full thickness resection (EFTR) performed for exophytic lesions. Out of 21 patients in the control group, 6 met criteria. Three patients had open wedge resection and three had laparoscopic resection. There was one moderate grade GIST in the endoscopic group but all others in both groups were low grade. The mean endoscopic removal time was 79.7 minutes. There were no significant complications in either group. However, surgical patients required analgesics including opioids, acetaminophen, throughout the whole hospitalization with greater frequency and duration. 9 out of 12 patients treated endoscopically required hospital admission while all six surgical patients were admitted. Endoscopic patients had shorter post-operative lengths of stay compared to surgery patients (2.08 vs 8.33 days). No recurrence was noted in either group. Conclusion: Endoscopic removal of gastric GISTs up to 5 cm in size is a safe and effective alternative to surgical resection with additional benefits of shorter length of hospital stay, decreased opioid use, and lower costs. It may be considered as an alternative method of GIST resection in centers with trained endoscopists.