The maximum transverse diameter: an effective indicator for predicting peroral en bloc retrieval rate of mesenchymal tumors after endoscopic resection.

Abstract

Gastrointestinal mesenchymal tumors (GIMTs) are being increasingly resected under endoscopy. Large GIMTs cannot be completely retrieved through the mouth, but the cut-off diameter of peroral en bloc retrieval (PEBR) for GIMTs completely resected is still unknown. This study aimed to investigate the ability of maximum transverse diameter (MTD) to predict the PEBR rate of GIMTs after endoscopic resection (ER). We retrospectively reviewed all patients who underwent ER for upper GIMTs from January 2009 to August 2023. The MTD was measured according to the maximum transverse diameter of specimen immediately retrieved after ER. For the PEBR rate, the independent predictors and optimal cut-off value of MTD were determined by logistic regression analysis and the receiver operating characteristic (ROC) curve analysis. The potential significance of preoperative CT for the evaluation of MTD was also clarified. A total of 2032 patients were diagnosed with upper GIMTs after en bloc resection under endoscopy. The overall PEBR rate was 98.72% (2006/2032). The PEBR rate was 100% for 1943 GIMTs with MTD < 2.5cm, 85.71% (60/70) for GIMTs with 2.5cm but ≤ 3.0cm, and 15.79% (3/19) for GIMTs with MTD > 3.0cm, and these rates were significantly different (P < 0.01). In terms of the PEBR rate of GIMTs, the ROC curve revealed that the optimal cut-off MTD value was 3.0cm, and logistic regression analysis revealed that MTD > 3.0cm was an independent predictive factor (OR 71.07, 95% CI 9.14-552.43; P < 0.001). The MTD of CT was related to that of the resected specimen (r = 0.7149, P < 0.01), and CT underestimated the mean MTD of upper GIMTs by 0.17cm (95% CI 0.09-0.24, P < 0.01). MTD is an effective indicator for predicting the PEBR rate of GIMTs after ER. Resected specimens with MTD > 3.0cm could not be routinely retrieved en bloc. Preoperative CT is suitable for evaluating the MTD of GIMTs, but underestimates the mean MTD of upper GIMTs by 0.17cm.