Abstract
Despite endoscopic resection has been performed to treat gastric gastrointestinal stromal tumor (GISTs). However, the safety and long-term outcomes remains controversial. This study aims to compare the safety and surgical outcomes of endoscopic versus laparoscopic resection of gastric GISTs. A total of 335 patients that were pathologically confirmed with gastric GISTs (tumor size ≤ 3.5 cm) were surgically treated with endoscopic resection (endoscopic group) or laparoscopic resection (laparoscopic group) in three institutions from March 1, 2011 to October 1 2014. These demographics, tumor characteristics, and outcomes were retrospectively analyzed for identification of outcomes and feasibility of endoscopic or laparoscopic resection. Of 335 patients, 262 and 73 patients underwent endoscopic and laparoscopic resection, respectively. The average tumor size was 1.33±0.78 cm in the endoscopic group and 1.97±0.93 cm in the laparoscopic group. The average operating time was 62.40±36.94 min in the endoscopic group and 112.81±55.69 cm in the laparoscopic group. Days of realimentation was 2.76±1.67 in the endoscopic group and 4.89±2.03 in the laparoscopic group. The average cost was $ 3246.01±1017.61 in the endoscopic group and $ 4884.81±1339.51 in the laparoscopic group. There was no postoperative mortality. Endoscopic resection for gastric GISTs is safe and feasible in tumors ≤ 3.5 cm. Because endoscopic resection showed good results with lower operating time, realimentation days, length of hospital stay and mean total cost, it is a minimally invasive and safe alternative approach which can achieve fast recovery and satisfactory outcomes for appropriately selected patients with gastric GISTs.
Highlights
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumor in the gastrointestinal tract [1, 2], the most common of which are KIT or PDGFRα activation mutations [3]
A total of 335 patients that were pathologically confirmed with gastric gastrointestinal stromal tumor (GISTs) were surgically treated with endoscopic resection or laparoscopic resection in three institutions from March 1, 2011 to October 1 2014
According to the patient inclusion and exclusion criteria, 335 patients were included into this study with 262 patients underwent endoscopic resection and the other 73 patients underwent laparoscopic resection (Figure 1)
Summary
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumor in the gastrointestinal tract [1, 2], the most common of which are KIT or PDGFRα (platelet-derived growth factor receptor alpha) activation mutations [3]. The median age at onset was about 60 years old, with biologically distinct subsets in the pediatric age group [8, 9]. Histological criteria show that malignancy tumors do not consistently exhibit aggressiveness. Tumor size and mitotic counts are recognized to assess prognosis. Using both indices, Fletcher and colleagues were able to classify patients with primary GISTs into four risk groups and to predict aggressive behavior. A model with a large number of patients with GISTs suggested that the anatomical location was the currently accepted risk model for local GISTs, and that the primary disease site, together with tumor size and mitotic count, provided a model of the risk of future relapse after local disease resection [10]
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