<p>Endoscopic or Surgical Resection for Patients with 2–5cm Gastric Gastrointestinal Stromal Tumors: A Single-Center 12-Year Experience from China</p>

Abstract

The surgical or endoscopic resection is the current treatment modality for 2-5 cm gastric gastrointestinal stromal tumors (GISTs). However, evidence is lacking as to which treatment modality is better. Our objective is to provide a new reference for the standardization of the treatment of 2-5 cm gastric GISTs. Patients and Methods: A retrospective study was conducted on 177 patients who underwent resection for 2-5cm gastric GISTs between January 2007 and July 2019 at Xiangya Hospital of Central South University. The cases were divided into surgical group (n=118) and endoscopic group (n=59). The clinical data, pathological and genetic characteristics, shortand long-term outcomes were compared. Results: Symptoms showed more obvious in the surgical group including abdominal pain and bleeding. In the endoscopic group, tumor size was smaller (p<0.001), and risk classification was lower (p<0.001). Patients in the endoscopic group had shorter anal exhaust time (p<0.001) and lesser hospital cost (p<0.001). However, the incidence rate of complications (25.42 vs 4.20%; p<0.001) and reoperation (22.03 vs 0.00%; p<0.001) in the endoscopic group was relatively higher than these in the surgical group. There was no significant difference in recurrence-free survival or overall survival between two groups. Conclusion: Gastric GISTs of 2-5cm may be suitable to select laparoscopic surgery.

Surgical Resection Is Still Better Than Endoscopic Resection for Patients With 2-5 cm Gastric Gastrointestinal Stromal Tumours: A Propensity Score Matching Analysis

“…After following up with the patients in our hospital for the last decade, we found that the recurrence rate did not differ significantly between the those undergoing the two techniques. Our findings are consistent with the published articles thus far ( 23 , 24 ).…”

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

“…However, with the development of EFR technology, tumors originating from the muscularis propria can also be removed by endoscopy. Considering that most of the previous studies on endoscopic treatment of gastrointestinal stromal tumors were mostly about small diameter tumors (< 5 cm) with small sample size and rarely evaluated long-term survival of patients [5,18], therefore, our study evaluated the long-term survival of surgery and endoscopic therapy in the treatment of GIST based on the American population.…”

“…In previous studies, endoscopic resection of gastrointestinal stromal tumors mostly included patients with a diameter smaller than 5 cm [5,8,26]. Considering that the diameter of the tumor is too large, it is difficult to achieve complete resection under an endoscope, which will increase the risk of positive margins; meanwhile, intentional perforation can lead to gastric content spillage and the risk of peritoneal seeding of cancer.…”

“…Surgical resection (open or laparoscopy) is the first choice for the treatment of GISTs [5]. GISTs rarely invade the adjacent structures and lymph nodes; therefore, it is unnecessary to expand the surgical margin and dissection lymph nodes [4].…”

Intragastric Single-Port Surgery: An Innovative and Multipurpose Technique for the Therapy of Upper Digestive Tract Lesions

“…For the abovementioned situations, endoscopic treatment might have potential risk of leading to unsatisfactory outcomes. 10,11 Laparoscopic resection usually needs intraoperative endoscopic control to ensure adequate oncologic margins, requiring advanced laparoscopic expertise. Based on current studies of single incision intragastric surgery, [12][13][14][15][16][17] our research group has developed a method of gaining access to the stomach by means of a percutaneous intragastric single-port device, which can be indicated for different upper digestive tract lesions, as the resection of gastric intraluminal tumors or bleeding lesions, 18 to gain access to the remnant stomach and perform ERCP after RYGB, 19 and revising the pancreaticogastric anastomosis after pylorus-preserving pancreaticoduodenectomy (PPPD).…”