Objective Endoscopic resection (ER) of gastric gastrointestinal stromal tumors (gGISTs) is a commonly used treatment; however, it is associated with a risk of conversion to laparoscopic resection (LR). This study was performed to identify factors influencing conversion from ER to LR and the effects of conversion on outcomes. Methods The clinicopathological features of patients treated for gGISTs from March 2010 to May 2021 were retrospectively collected. Endpoints included the determination of risk factors associated with LR conversion, with comparisons of surgical outcomes with and without conversion. Propensity score matching was performed to compare the two groups. Results In total, 371 gGISTs were analyzed. Sixteen patients required conversion from ER to LR. Propensity score matching demonstrated that invasion depth (muscularis propria with exophytic growth) and gGIST size (≥3 cm) were independent risk factors for conversion to LR. The procedure duration (median, 160.5 vs. 60.0 minutes), postoperative hospitalization duration (median, 8 vs. 6 days), and postoperative fasting duration (median, 5 vs. 3 days) were significantly longer in patients who underwent conversion to LR. Conclusions Accurate preoperative measurements of tumor size and invasion depth may help determine more appropriate surgical approaches for patients with gGISTs.
Background: Endoscopic resection (ER) of gastric gastrointestinal stromal tumors (gGISTs) is a commonly used treatment; however, there is a risk of conversion to laparoscopic resection (LR). The purpose of this study was to determine factors influencing conversion from ER to LR, and the effects of such a conversion on outcomes.Methods: From March 2010 to May 2021, patients with gGISTs were retrospectively reviewed at the First Affiliated Hospital of Soochow University, Suzhou, China. Patient’s clinicopathological features and endoscopic procedure information were collected. Endpoints included the determination of risk factors associated with ER conversion to LR, with comparisons of surgical outcomes with and without conversion.Results:In total, 371 gGISTs were analyzed. Sixteen patients (4.3%) required conversion to LR during gGIST ER. Invasion depth (muscularis propria (MP)-ex: odds ratio (OR) 16.026, 95% confidence interval (CI): 2.949–87.092, p<0.001) and gGIST size (≥ 3 cm: OR 6.747, 95% CI: 2.062–22.071, p=0.002) were independent risk factors for LR conversion. Conversion reasons included technical difficulties (nine patients had severe intraoperative bleeding and five had failed gastric perforation closure) and ER accidents (two patients had tumors accidentally fell into the abdominal cavity). Procedure (median 160.5 vs. 58.0 min, p<0.001), postoperative hospitalization (median 8 vs. 6 days, p<0.001), and postoperative fasting times (median 5 vs. 3 days, p<0.001) were significantly longer in LR conversion patients.However, En bloc R0 resection (93.8 vs. 90.4%, p>0.999) and recurrence (0 vs. 0.6%, p>0.999) were no different in patients with or without LR conversion. Conclusions: An increased awareness of conversion risk factors is important for better patient selection for gGIST ER. Accurate preoperative measurements of tumor size and invasion depth can help determine more appropriate surgical approaches for patients.
Background The relationship between serum uric acid (SUA) and nonalcoholic fatty liver disease (NAFLD) has been previously reported. Controlled attenuation parameter (CAP) has better diagnostic performance than ultrasonography for assessing hepatic steatosis. The association of SUA with hepatic steatosis detected by CAP is worth further study. Methods The US population aged 20 years or older from the National Health and Nutrition Examination Survey (NHANES) was assessed. Hepatic steatosis was evaluated by the controlled attenuation parameter (CAP). NAFLD status was defined as CAP values of 268 dB/m without hepatitis B or C virus infection or considerable alcohol consumption. Multiple imputations were performed to fill in the missing covariate values. Linear regression, logistic regression, and smooth curve fitting were used to examine the association. Results In total, 3919 individuals participated in this study. There was a positive association between SUA (µmol/L) and CAP (β = 0.14, 95% CI: 0.12-0.17, P < 0.01). After stratification by sex, a significant relationship between SUA and CAP existed in both males (β = 0.12, 95% CI: 0.09-0.16, P < 0.01) and females (β = 0.17, 95% CI: 0.14-0.20, P < 0.01) after multiple imputation. The inflection points of the threshold effect of SUA on CAP were 487.7 µmol/L in males and 386.6 µmol/L in females. There was a positive association between SUA (mg/dL) and NAFLD (OR = 1.30, 95% CI: 1.23-1.37, P < 0.01). After stratification by race, positive relationships were also observed. Meanwhile, a positive relationship existed between hyperuricemia and NAFLD (OR = 1.94, 95% CI: 1.64-2.30, P < 0.01). The positive relationship was more significant in females than in males (P for interaction < 0.01). Conclusions There was a positive association between SUA and CAP, as well as between SUA and NAFLD. Subgroup studies stratified by sex and ethnicity demonstrated that the effects were consistent.
Financial support: this study was supported by Health Personnel Training Project of Soochow (GSWS2020109) and Changshu Science and Technology Project (CS202116).
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