Endoscopic versus laparoscopic resection of gastric gastrointestinal stromal tumors: a multicenter study

Wei-jie, Dai; Gao, Liu; Wang, Min; Liu, Wenjie; Song, Wei; Yang, Xiaozhong; Wang, Qilong; Zhang, Xiaoyu; Fan, Zhining

doi:10.18632/oncotarget.13298

Cited by 20 publications

(22 citation statements)

References 25 publications

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“…In this study, the fundus of stomach is the most common location of GISTs. In total, 96.9 % (189/195) and 99.5 % (194/195) of the included population were positive for CD117 and CD34, respectively, consistent with a previous report of a multicenter study performed in China 23 .…”

Section: Discussionsupporting

confidence: 90%

Tumor rupture of gastric gastrointestinal stromal tumors during endoscopic resection: a risk factor for peritoneal metastasis?

et al. 2018

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Background and study aims Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the gastrointestinal tract. Up to the present time, complete surgical excision has been the standard treatment for primary GISTs greater than 2 cm. It is well known that tumor rupture during surgery is an independent risk factor for peritoneal metastasis; however, it is not known whether the risk of peritoneal metastasis increases in cases where the tumor is ruptured during endoscopic resection. Patients and methods A total of 195 patients treated for GIST between January 2014 and December 2016 in our hospital were enrolled in this study. They were divided into two groups according to whether the tumor was ruptured during endoscopic resection. The rate of peritoneal metastasis in patients in the two groups who also suffered perforation was investigated from the follow-up results. Results Approximately 55.4 % of all patients were female and the average age of the study group was 59.0 ± 10.3 years. Of the 195 patients, the tumors in 27 were ruptured and the remaining 168 patients underwent en bloc resection. There was no statistically significant difference in gender or age between the two groups. The median tumor size (maximum diameter) in all patients was 1.5 cm (0.3 – 5.0 cm): 2.5 cm (0.8 – 5.0 cm) and 1.4 cm (0.3 – 4.0 cm) in the tumor rupture group and en bloc resection group, respectively ( P < 0.001). Most of the tumors were located in the gastric fundus. At a median follow-up of 18.7 ± 10.2 months, neither tumor recurrence (liver metastasis, peritoneal metastasis, local recurrence) nor mortality related to GISTs were detected. Conclusions Tumor rupture during endoscopic resection of gastric GISTs may not be a risk factor for peritoneal metastasis.

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Section: Discussionsupporting

confidence: 90%

Tumor rupture of gastric gastrointestinal stromal tumors during endoscopic resection: a risk factor for peritoneal metastasis?

et al. 2018

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“…Concerning the postoperative outcomes, although some previous studies have shown that the incidence of postoperative complications was equivalent between the two groups, 32,34 Jeong et al . 29 revealed that the postoperative adverse events were more common in the LAR group than in endoscopic operation patients.…”

Section: Discussionmentioning

confidence: 89%

“…Among the remaining 68 reports, 58 were excluded on account of insufficient data and failure to meet the criteria. Finally, 10 publications 26–35 published from 2012 to 2018 were enrolled in our current meta‐analysis, as exhibited in Figure 1. All studies were conducted in either China (nine studies) or Korea (one study).…”

Section: Resultsmentioning

confidence: 99%

“…According to the latest international guidelines from the National Comprehensive Cancer Network, 46 LAR is recommended for gastric GISTs located in the greater curvature or anterior wall of the stomach in an experienced medical center, whereas there is no clear statement about ESR for the treatment of gastric GISTs. To date, several studies have made an attempt to settle this dispute, 26–35 but the efficiency and safety of these two procedures for treating gastric GISTs remain indefinite due to different surgeons' skills in different medical institutions. Therefore, we carried out the study to analyze the clinical outcomes between ESR and LAR in patients with gastric GISTs.…”

Section: Discussionmentioning

confidence: 99%

“…Despite several publications comparing ESR versus LAR for gastric GISTs and reporting their outcomes, 26–35 there are limited studies of large sample size about the two minimally invasive methods. Hence, we initiated the meta‐analysis to compare the therapeutic validity/safety between ESR and LAR in the treatment of patients with gastric GISTs.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of endoscopic versus laparoscopic resection for gastric gastrointestinal stromal tumors: A preliminary meta‐analysis

Zhu

Zhao

Jiao

et al. 2020

J of Gastro and Hepatol

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Background and Aim For localized disease, complete surgical resection is regarded as the “gold standard” therapeutic modality. With the rapid development of endoscopic techniques, endoscopic resection (ESR) has been confirmed as an efficient and safe alternative for the treatment of gastrointestinal stromal tumors (GISTs) in the stomach. Nevertheless, the management of gastric GISTs remains poorly defined. The purpose of this study is to evaluate the security and effectiveness of ESR with laparoscopic resection (LAR) for gastric GISTs. Methods A literature search of online databases was conducted to identify relevant comparative studies of ESR and LAR procedures for gastric GISTs published before April 10, 2020. The cumulative data analysis was also performed utilizing the software STATA. Results In total, 10 studies involving 1165 patients met the inclusion criteria for analysis (651 for ESR and 514 for LAR). From the results of meta‐analysis, patients who underwent ESR experienced decreased operative time (P = 0.000), less intraoperative blood loss (P = 0.002), earlier time to diet (P = 0.000), shorter hospital stay (P = 0.000), and lower total charges (P = 0.000) compared with LAR. Moreover, there were no significant differences between these two approaches concerning tumor rupture, conversion rate to other procedure, complete resection rate, postoperative complication rate, recurrence rate, and disease‐free survival. Conclusions Endoscopic resection, as an effective alternative treatment strategy with satisfactory outcomes, is acceptable for selective patients with gastric GISTs compared with LAR. Further well‐designed randomized controlled trials with large samples are warranted to corroborate our observations.

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Comparable long-term survival of patients with colorectal or gastric gastrointestinal stromal tumors treated with endoscopic vs. surgical resection

et al. 2021

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Background and aimsWith the development of endoscopic technology, endoscopic treatment has been widely used in Gastrointestinal stromal tumors (GISTs). However, population-based studies comparing the long-term results of patients who received endoscopic treatment vs. Surgery are lacking. We used the Surveillance, Epidemiology, and End Results (SEER) database to analyze the long-term survival of colorectal or gastric GISTs who underwent primary tumor resection (endoscopic therapy or surgery) in the USA. Methods Patients with colorectal or gastric GISTs were selected from the SEER database between 2010 and 2015. Kaplan-Meier analyses and log-rank tests were used to evaluate the difference in the long-term survival between the endoscopic therapy group and the surgery group. We examined the association between different treatments and survival after using the multivariate cox proportional hazards model to adjust the relevant covariates. Besides, we used Propensity score matching (PSM) to overcome the different distributions of covariates between the two groups and then further compare the survival difference. Results In total, 2355 patients were enrolled in our study, of which 1999 (84.9%) received surgical treatment and 356 (15.1%) received endoscopic treatment. There was no significant difference in overall survival (OS) between the two groups before PSM. The median OS (73.5 months vs. 72.2 months) and 5-year OS rate (85.7% vs. 81.5%) of endoscopic therapy were similar to surgical patients (P = 0.34). The median Cancer-specific survival (CSS) and 5-year CSS rate in the endoscopic treatment group were higher than the surgical group before PSM, with 81.3 months, 97.1% versus 78.8 months, 92.7% (P = 0.011). After adjusting for other clinical factors and PSM, the long-term OS and CSS did not significantly differ between those treated surgically and treated endoscopically. Conclusion Based on the American population, we preliminarily found that the long-term OS and CSS did not differ between patients undergoing endoscopic therapy and surgery.

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Endoscopic versus laparoscopic resection of gastric gastrointestinal stromal tumors: a multicenter study

Cited by 20 publications

References 25 publications

Tumor rupture of gastric gastrointestinal stromal tumors during endoscopic resection: a risk factor for peritoneal metastasis?

Tumor rupture of gastric gastrointestinal stromal tumors during endoscopic resection: a risk factor for peritoneal metastasis?

Comparison of endoscopic versus laparoscopic resection for gastric gastrointestinal stromal tumors: A preliminary meta‐analysis

Comparable long-term survival of patients with colorectal or gastric gastrointestinal stromal tumors treated with endoscopic vs. surgical resection

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