Abstract
Objective To investigate the feasibility of laparoscopic and endoscopic cooperative dissection (LECD) for small gastric gastrointestinal stromal tumors (GISTs) without causing injury to the mucosa, compared with ESD surgery which is widely used now. Methods A total of 25 patients with small gastric GISTs who underwent LECD and 20 patients with small gastric GISTs who underwent ESD between October 2014 and June 2016 were included in this study. All patients underwent curative resection for pathologically diagnosed small gastric GISTs. Patients' clinical data were retrospectively analyzed. Results In LECD group, the operation was successfully performed in all patients. However, in the ESD group, three patients were transferred to laparoscopic surgery due to intraoperative massive bleeding or intraoperative perforation. No additional targeted chemotherapy drugs for interstitial tumors were prescribed in two groups. There was no difference in the complete tumor capsule rate (100% vs. 90%, p = 0.11), operation time (80.76 ± 13.86 ml vs. 84.05 ± 15.33 ml, p = 0.45), major intraoperative bleeding (0 vs. 5%, p = 0.26), postoperative bleeding (0 vs. 10%, p = 0.11), and postoperative infection (0 vs. 10%, p = 0.11) between the two groups. Compared to ESD (endoscopic submucosal dissection), LECS patients had shorter postoperative indwelling gastric tube (1.04 ± 0.98 d vs. 2.85 ± 0.24 d, p < 0.01), earlier postoperative eating (1.96 ± 0.98 d vs. 3.50 ± 1.15 d, p < 0.01), shorter average postoperative hospital stay (3.44 ± 1.00 d vs. 7.85 ± 1.18 d, p < 0.01), smaller perforation rate (0 vs. 25%, p < 0.05), and fewer surgical supplies. No recurrence or metastasis cases were found between the two groups during the follow-up period, and there were no cases of death due to gastric GISTs. Conclusion LECD is a novel surgery for small gastric gastrointestinal stromal tumors that leads to satisfactory short-term outcomes and meets the idea of minimally invasive surgery and rapid recovery; compared with ESD, LECD surgery has some advantages in clinical practice. However, further follow-up is needed to confirm.
Highlights
Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm that can be found in any part of the digestive system; the most common sites are the stomach and small intestine
A total of 25 patients with small gastric GISTs who underwent laparoscopic and endoscopic cooperative dissection (LECD) and 20 patients with small gastric GISTs who underwent endoscopic submucosal dissection (ESD) between October 2014 and June 2016 were included in this study
Epidemiological studies have confirmed that the incidence of small mesenchymal tumors in the stomach is much higher than that of interstitial tumors [2]
Summary
Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm that can be found in any part of the digestive system; the most common sites are the stomach and small intestine. The annual incidence of GIST ranges between 1 and 2 per 100,000, and 20%~35% of these are small GISTs (tumor with less than 2 cm in diameter) [1, 2]. Surgical resection remains the main therapeutic approach for nonmetastatic GISTs [3, 4]. Laparoscopic and endoscopic cooperative wedge resection has been widely accepted and is considered to be a minimally invasive surgery for GISTs in the stomach. Wedge resection often causes damage to gastric mucosa.
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