Background and Aims
We aimed to investigate the safety and efficacy of endoscopic resection (ER) compared
with surgical resection (SR) of gastric GI stromal tumors (GISTs).
Methods
This study included 51 and 403 patients who underwent ER and SR, respectively, for ≤5
cm GISTs in the stomach between June 2005 and August 2017. After propensity score
matching (1:1) using age, sex, tumor size, mitotic count, and comorbidities, the oncologic
outcomes were compared with 48 patients each from ER and SR groups.
Results
The ER group had significantly shorter hospital stay (4.4 ± 2.9 vs 6.6 ± 3.6 days,
P < .001) and procedure time (38.3 ± 24.2 vs 66 ± 33.3 min, P < .001). The R0 resection rate was 62.7% in the ER group and 98.5% in the SR group.
In the ER group, macroperforation occurred in 6 patients (11.8%) with a tumor located
in the fundus (4/6, 66.7%) or body (2/6, 33.3%). All cases of perforation were cured
with conservative treatment. In the SR group, postoperative adverse events such as
stricture and leakage occurred in 7 patients (1.7%) with a tumor located in the antrum
(4/7, 57.1%) or cardia (3/7, 42.9%). After matching, the overall mean follow-up period
was 47.9 ± 37.8 months in the ER group and 41.3 ± 22.6 months in the SR group. No
recurrence or distant metastasis occurred in either group during the follow-up period.
Conclusions
ER is an effective and safe therapeutic method that might be comparable with SR for
treating small-sized (≤5 cm) gastric GISTs. Selecting the resection method according
to the tumor location seems appropriate.
Abbreviations:
CI (confidence interval), ER (endoscopic resection), GIST (GI stromal tumor), HPF (high-power field), HR (hazard ratio), SR (surgical resection), STER (submucosal tunneling endoscopic resection)To read this article in full you will need to make a payment
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References
- Gastrointestinal stromal tumors—definition, clinical, histological, immunohistochemical, and molecular genetic features and differential diagnosis.Virchows Arch. 2001; 438: 1-12
- Gastrointestinal stromal tumours: ESMO-EURACAN clinical practice guidelines for diagnosis, treatment and follow-up.Ann Oncol. 2018; 29: iv267
- Endoscopic treatments for small gastric subepithelial tumors originating from muscularis propria layer.World J Gastroenterol. 2015; 21: 9503-9511
- Endoscopic versus open resection for small gastric gastrointestinal stromal tumors: safety and outcomes.Medicine (Baltimore). 2015; 94: e376
- Efficacy and safety of endoscopic submucosal dissection in treating gastric subepithelial tumors originating in the muscularis propria layer: a single-center study of 144 cases.Scand J Gastroenterol. 2013; 48: 1466-1473
- Endoscopic submucosal dissection for treatment of gastric subepithelial tumors (with video).Gastrointest Endosc. 2012; 75: 276-286
- Endoscopic versus surgical resection of GI stromal tumors in the upper GI tract.Gastrointest Endosc. 2016; 83: 318-326
- Endoscopic submucosal dissection for gastric gastrointestinal stromal tumors: a retrospective cohort study.Surg Endosc. 2017; 31: 4522-4531
- Endoscopic resection of gastric gastrointestinal stromal tumors.Transl Gastroenterol Hepatol. 2017; 2: 115
- Safety of endoscopic resection for upper gastrointestinal subepithelial tumors originating from the muscularis propria layer: an analysis of 733 tumors.Am J Gastroenterol. 2016; 111: 788-796
- Efficacy of endoscopic submucosal excavation for gastrointestinal stromal tumors in the cardia.Surg Laparosc Endosc Percutan Tech. 2016; 26: 493-496
- Long-term outcomes of endoscopic resection of gastric GISTs.Surg Endosc. 2017; 31: 4799-4804
- Risk criteria and prognostic factors for predicting recurrences after resection of primary gastrointestinal stromal tumor.Ann Surg Oncol. 2007; 14: 2018-2027
- Diagnosis of gastrointestinal stromal tumors: a consensus approach.Hum Pathol. 2002; 33: 459-465
- Clinical course of gastrointestinal stromal tumor diagnosed by endoscopic ultrasound-guided fine-needle aspiration.Dig Endosc. 2015; 27: 44-52
- Minimally invasive treatment of gastric gastrointestinal stromal tumors: laparoscopic and endoscopic approach.Surg Laparosc Endosc Percutan Tech. 2012; 22: 244-250
- Clinical impact of EUS-guided Trucut biopsy results on decision making for patients with gastric subepithelial tumors ≥ 2 cm in diameter.Gastrointest Endosc. 2011; 74: 1010-1018
- Yields and utility of endoscopic ultrasonography-guided 19-gauge trucut biopsy versus 22-gauge fine needle aspiration for diagnosing gastric subepithelial tumors.Clin Endosc. 2015; 48: 152-157
- Comparison of endoscopic and open resection for small gastric gastrointestinal stromal tumor.Transl Oncol. 2015; 8: 504-508
- Survival benefit of additional surgery after noncurative endoscopic resection in patients with early gastric cancer.Gastrointest Endosc. 2017; 85: 155-163
- Survival benefit of additional surgery after non-curative endoscopic submucosal dissection for early gastric cancer: a propensity score matching analysis.Ann Surg Oncol. 2017; 24: 3353-3360
- Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival.Ann Surg. 2000; 231: 51-58
- Predictors of recurrence after resection of small gastric gastrointestinal stromal tumors of 5 cm or less.J Clin Gastroenterol. 2012; 46: 130-137
- Microscopically positive margins for primary gastrointestinal stromal tumors: analysis of risk factors and tumor recurrence.J Am Coll Surg. 2012; 215 ([discussion: 9-60]): 53-59
- Interpretation of pathologic margin after endoscopic resection of gastrointestinal stromal tumor.Clin Endosc. 2016; 49: 229-231
- Surgical margin status and prognosis of gastrointestinal stromal tumor.World J Surg. 2008; 32: 2375-2382
- Advanced gastrointestinal stromal tumor in Europe: a review of updated treatment recommendations.Expert Rev Anticancer Ther. 2009; 9: 831-838
Article info
Publication history
Published online: October 23, 2019
Accepted:
October 10,
2019
Received:
May 11,
2019
Footnotes
DISCLOSURE: All authors disclosed no financial relationships.
Identification
Copyright
© 2020 by the American Society for Gastrointestinal Endoscopy
ScienceDirect
Access this article on ScienceDirectLinked Article
- Endoscopic resection: Comparable with surgical resection for treating small-sized gastric GI stromal tumors?Gastrointestinal EndoscopyVol. 91Issue 6
- PreviewWe read the article by Kim et al1 with great interest. The authors compared endoscopic resection (ER) with surgical resection (SR) for gastric GI stromal tumors (GISTs) by using propensity score matching. The result showed that ER is an effective and safe therapeutic method for treating small (≤5 cm) gastric GISTs. However, we have the following concerns, and we would appreciate the authors' reply about some details.
- Full-Text
- Preview
- Comparison between endoscopic and surgical resection of gastric GI stromal tumorsGastrointestinal EndoscopyVol. 92Issue 2
- PreviewWe have read with great interest the article by Kim et al,1 which retrospectively compared the safety and efficacy of endoscopic resection (ER) with surgical resection (SR) for treating gastric GI stromal tumors (GISTs). The authors reported that both ER and SR are effective and safe therapeutic methods for the resection of small (≤5 cm) gastric GISTs. Their findings suggested that tumor location could be a predictive factor to determine the method of resection.
- Full-Text
- Preview
