J Cancer 2019; 10(17):4132-4141. doi:10.7150/jca.29443 This issue

Research Paper

Comparison of Safety and Outcomes between Endoscopic and Surgical Resections of Small (≤ 5 cm) Primary Gastric Gastrointestinal Stromal Tumors

Taohong Pang1,2#, Yan Zhao3#, Ting Fan4#, Qingqing Hu1, Dekusaah Raymond4, Shouli Cao1, Weijie Zhang5, Yi Wang1, Bin Zhang1, Ying Lv1, Xiaoqi Zhang1, Tingsheng Ling1, Yuzheng Zhuge1, Lei Wang1✉, Xiaoping Zou1✉, Qin Huang1,6✉, Guifang Xu1,4✉

1. Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School.
2. Department of Gastroenterology, Affiliated Chaohu Hospital of Anhui Medical University.
3. Department of Geriatric, Affiliated Drum Tower Hospital of Nanjing University Medical School.
4. Department of Gastroenterology, Nanjing Drum Tower Clinical College of Nanjing Medical University.
5. Department of General Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School.
6. VA Boston Healthcare System and Harvard Medical School, West Roxbury, MA 02132, USA.
# These authors contributed equally to the work.

This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions.
Citation:
Pang T, Zhao Y, Fan T, Hu Q, Raymond D, Cao S, Zhang W, Wang Y, Zhang B, Lv Y, Zhang X, Ling T, Zhuge Y, Wang L, Zou X, Huang Q, Xu G. Comparison of Safety and Outcomes between Endoscopic and Surgical Resections of Small (≤ 5 cm) Primary Gastric Gastrointestinal Stromal Tumors. J Cancer 2019; 10(17):4132-4141. doi:10.7150/jca.29443. Available from https://www.jcancer.org/v10p4132.htm

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Abstract

Background and aims: Endoscopic resection is increasingly performed for gastric gastrointestinal stromal tumors (GIST). However, the safety and outcomes remain elusive. We aimed in this retrospective study to compare operative complications and prognosis between endoscopically and surgically resected small (≤ 5 cm) GIST tumor groups.

Methods: In this single-center retrospective study, we compared demographics, clinical outcomes, and the R0 resection rate between the endoscopy (n =268) and surgery (n =141) groups. Only GIST tumors in size of ≤ 5.0 cm were recruited for this comparison study.

Results: Overall, the mean age of patients was 59.0 years (range: 31.0-83.0). The male-female ratio was 0.68. The most common site of GIST was, in the descending order, the gastric fundus (55%), corpus (27.6%), cardia (10.8%), and antrum (6.6%). Compared with the surgery group, GIST tumors in the endoscopy group were significantly smaller (1.69±0.9 cm, vs. 3.20±1.2 cm in the surgery group; P <0.001) in size; postoperative hospital stay was significantly shorter (4.66±1.5 days, vs. 8.11±5.0; P <0.001); post-resection time to first liquid diet was significantly shorter (1.94±1.1 days, vs. 4.63±2.6; P < 0.001); the incidence of operative and post-operative complications was significantly fewer (p < 0.05), and hospital costs were significantly lower (20115.4±5113.5¥, vs. 43378.4±16795.7¥; P < 0.001). The R0 resection rate was significantly lower in the endoscopy (93.3%) than in the surgery (99.3%) groups (P< 0.01). In the endoscopy group, 176 (65.7%) and 69 (25.7%) patients were found to be at very low and low risk of aggressiveness, respectively, in comparison to 27(19.2%) and 86 (61.0%) patients in the surgery group, respectively (P <0.001). Among 409 cases, 50 (12.2%) were found to be at intermediate or high risk of aggressiveness, 20 of which were treated with adjuvant imatinib therapy and but only 8/20 taking imatinib for 1 to 3 months because of side effects and high costs. No local or distant tumor recurrence was observed over an average of 33.5-month follow-ups. Two patients died of other disease in the surgery group.

Conclusions: Endoscopic resection of selected small gastric GISTs (≤ 5cm) was feasible, safe, and associated with better intraoperative results and an equal postoperative course, compared to surgical resection.

Keywords: Gastric gastrointestinal stromal tumors, Endoscopic resection, Surgical resection, Operative complications, Postoperative course, Adjuvant therapy with imatinib