S1605 Comparable Outcomes of Endoscopic, Surgical, and Hybrid Resection of Gastric GIST

Abstract

Introduction: Gastrointestinal stromal tumors (GIST) are rare, comprising < 1% of all gastrointestinal tumors, and most commonly arise in the stomach (60%). Surgical resection (SR) has been the mainstay of therapy, however endoscopic resection (ER) is being performed for small lesions, while hybrid resection (HR) can be used for bigger lesions, both becoming a viable alternative to surgery. We aimed to analyze Gastric GIST (G-GIST) management trends, compare outcomes, and hospital resource utilization between ER, SR, and HR techniques in the USA. Methods: Using ICD-10 diagnosis code for G-GIST (C49.A2), we extracted adult ( >20y) patients’ data from Nationwide Inpatient Sample (2017-2019yy). We used the procedure codes for ER (0D568ZZ, 0DB68ZZ, 0DT78ZZ), open and laparoscopic SR(0D564ZZ, 0DB64ZZ, 0DB60ZZ, 0DT74ZZ,0DT70ZZ), and HR (endoscopic and laparoscopic codes combined), and defined technical procedural and systemic complications. Mortality, complications, length of stay (LOS), and hospitalization charges were used as outcomes. Statistical analysis was performed with SAS. Results: A total of 145 ER, 7875 SR, and 70 HR procedures for G-GIST management was identified. According to different approaches, there was no difference in primary payer types or median household income. There was slight male to female predominance in ER and HR but not in the SR group. Racial disparities were noted in the ER >SR but not in HR (Figure). Most procedures were performed in teaching institutions: ER (93%), SR (86%), and HR (86%). Mortality for SR was 0.8%, and no inpatient deaths were recorded for ER or HR. Mean charges were highest for HR ($163,794) and lowest for ER ($86,811), with LOS highest for HR (10.7d), followed by ER (∼7d) and SR (5.5d). More complications were noted in HR (43%, vs 28% in ER and 18% in SR) (Table). Most SR and HR patients were discharged home (94% and 93%, respectively); A lesser percentage of ER (72%) were discharged home with a relatively higher percentage of 28% sent to long-term care facilities compared to SR (5%) and HR (7%). Conclusion: Minimally invasive management of G-GIST is evolving, with surgery still being most common. Both endoscopic and hybrid techniques are promising alternatives to surgery and show a lower mortality rate, however, with a higher percentage of non-fatal complications (both), increased cost (HR only), and increased LOS (both) compared to SR. Larger studies can help guide providers in choosing the optimal individual approach in G-GIST management.Figure 1.: Sociodemographic Analysis of Endoscopic, Surgical and Hybrid Gastric GIST Resection Table 1. - Hospital Resource Utilization and Complications for Endoscopic, Surgical and Hybrid Gastric GIST Resection Endoscopic Resection 95% CI Surgical Resection 95% CI Hybrid Resection 95% CI Mean Charges $86,811 $54,981-$118,641 $93,112 $87,943-$98,280 $163,794 $114,128-$213,461 Mean Length of Stay (days) 6.9 4.6-9.2 5.5 5.2-5.8 10.7 7.1-14.4 Complications 27.6% 11.2-44% 17.8% 15.9-19.7% 42.9% 16.8-68.9%