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Comparison of the treatment outcomes of endoscopic and surgical resection of GI stromal tumors in the stomach: a propensity score–matched case-control study

Published:October 23, 2019DOI:https://doi.org/10.1016/j.gie.2019.10.020

      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)
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      Linked Article

      • Endoscopic resection: Comparable with surgical resection for treating small-sized gastric GI stromal tumors?
        Gastrointestinal EndoscopyVol. 91Issue 6
        • Preview
          We 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
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      • Comparison between endoscopic and surgical resection of gastric GI stromal tumors
        Gastrointestinal EndoscopyVol. 92Issue 2
        • Preview
          We 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
        • PDF