Evaluation of clinical treatment of primary small gastric gastrointestinal stromal tumors: a retrospective single-center study

Abstract

Objective To investigate the clinicopathologic features of primary small gastrointestinal stromal tumors (GISTs) and to evaluate the efficacy and safety of endoscopic resection based on ESD. Methods A retrospective analysis was performed in patients with pathologically proved small GISTs who underwent endoscopic resection(n=107) or surgery including open laparotomy or laparoscopic surgery(n=36) at Drum Tower Hospital from January 2012 to June 2015.The clinicopathologic features, treatment, adverse events, and prognosis were evaluated. Results 1) A total of 143 patients were included in the study, 79.7% of whom with small GISTs were asymptomatic. Approximately 53.8% of GISTs occurred in the fundus of stomach. The median tumor size was 1.3 cm. Preoperative endoscopic ultrasonography (EUS) revealed they were all classified as very low risk. Histological examinations showed that 112 (78.3%) patients were classified as very low risk, 24 (16.8%) as low risk, 4 (2.8%) as moderate risk and 3 (2.1%) as high risk. Subgroup analysis suggested that the size of GISTs classified in moderate or high risk ranged from 1 to 2 cm. 2) The complete resection rate was close, 90.7% in endoscopy group and 100% in surgery group, respectively. Hospital stay was shorter in endoscopy group than that in surgery group (5 d VS 8 d, P<0.001). And the incidence of postoperative infection was lower in endoscopic group than in surgical group (0.9% VS 19.4%). No recurrence or metastasis was detected, with the median follow-up period of 24 months. Conclusion In most of the cases, small gastric gastrointestinal stromal tumors occur in the fundus of stomach. Most patients with GISTs are asymptomatic, most of which are classified as very low risk or low risk. Preoperative EUS has a limited value in evaluating invasive risk of small gastric GISTs. Endoscopic therapy based on ESD is feasible and safe in managing small gastric GISTs if complete resection can be assured. Key words: Small gastric stromal tumor; Endoscopy; Ultrasonography; Endoscopic submucosal dissection; Retrospective studies