| BackgroundGastrointestinal stromal tumors(GIST)are the most common mesenchymal tumors of the digestive tract,which are potentially aggressive.GIST can be found in all digestive tract,of which the stomach is the most common.Since GIST with a smaller diameter may also metastasize,the consensus recommends that all gastric stromal tumors with a maximum diameter≥2 cm should be resected.Many studies proved that endoscopic resection is safe and effective of the treatment of gastric stromal tumors with a size of 3-5 cm.However,there are only case reports and lacking larger sample and comparative study about endoscopic resection of the treatment of gastric stromal tumors with a maximum diameter more than 5 cm.ObjectThrough retrospective analysis of the clinical data of endoscopic full-thickness resection(EFTR)and surgical resection(including laparoscopic and open surgery)for the treatment of large gastric stromal tumors with a maximum diameter of 5-7 cm,the safety and effectiveness of EFTR of giant gastric stromal tumor with a maximum diameter of 5-7cm were discussed.Methods1.SubjectsData of 36 large gastric stromal tumors with a maximum diameter of 5-7cm patients who received EFTR or surgical resection(including laparoscopic and open surgery)in the first affiliated hospital of Zhengzhou university and confirmed by postoperative histopathology and immunohistochemistry from January 2017 to December 2018 were retrospective analyzed.2.Case of groupAccording to the operation method,it was divided into an endoscopic group(9 cases)and a surgical group(27 cases);the surgical group included laparoscopic surgery(24 cases)and open surgery(3 cases).3.Observation indicatorsThe observation indicator including general indicator(gender,age,clinical manifestations,tumor size,tumor location,tumor growth pattern),perioperative indicators(operation time,intraoperative hemorrhage volume,Visual Analogue Scale(VAS)for abdominal pain and white blood cell count on first and third postoperative day,the incidence of postoperative fever,the incidence of intraoperative and postoperative complications,postoperative fasting time,hospital stay,hospitalization expenses),and pathological indicators(pathological type,CD117,CD34,DOG-1 positive rate,pathological risk classification).4.Follow-upFollow-up is carried out every 3-6 months after the operation.The follow-up methods include telephone and outpatient review.The deadline for follow-up is March 2021.The follow-up time,recurrence and metastasis rate are recorded.5.Statistical analysisThe statistical software SPSS version 26.0 was used for data analysis.The measurement data conforming to the normal distribution were expressed by Mean ±SD,and the independent sample t test was performed;the measurement data that does not conform to the normal distribution were represented by the M(P25,P75),and the Mann-Whitney U test is performed;the qualitative data is expressed by relative numbers(percentage and composition ratio),Fisher’s exact test is performed;P<0.05 was considered as the difference was statistically significant.Result1.General informationThe average age of the endoscopic group was 64.11± 11.49 year-old,the surgical group was 56.81± 12.51 year-old;the ratio of male to female in endoscopic group was 1:1.3,in the surgical group was 1:0.5.There was no statistically significant difference in the above indicators between the two groups(P>0.05).2.Clinical manifestationsIn endoscopic group,5 cases(55.5%)presented with gastrointestinal hemorrhage,4 cases(44.5%)presented with abdominal discomfort.In the surgical group,9 cases(33.4%)presented with gastrointestinal hemorrhage,12 cases(44.4%)presented with abdominal discomfort,4 case(14.8%)were found through physical examination and 2 case(7.4%)presented with other rare symptoms.3.Lesion characteristics3.1 Lesion size The median tumor size in the endoscopic group was 5.1 cm,in the surgical group was 5.5 cm;there was no statistically significant difference between the two groups(P>0.05).3.2 Lesions region In the endoscopic group,6 cases(66.7%)were located in the fundus of the stomach,3 cases(33.3%)in the stomach body.In the surgical group,11cases(40.7%)were located in the fundus of the stomach,13 cases(48.1%)in the stomach body,and 3 cases(11.2%)in the antrum of the stomach.There was no significant difference between the two groups(P>0.05).3.3 Lesion growth patten In the endoscopic group,5 cases(55.5%)showed intracavitary growth,4 cases(44.5%)showed intracavitary and extracavity mixed growth.In the surgical group 10 cases(37.0%)showed intracavitary growth,11 cases(40.7%)showed extracavity growth,6 cases(22.3%)showed intracavitary and extracavity mixed growth.There was no significant difference between the two groups(P>0.05).4.Perioperative indicatorsCompared with surgical group,the endoscopic group had lower abdominal pain VAS scores on the 1st and 3rd postoperative day,short postoperative fasting time and hospital stay,and lower hospitalization costs,but the operation time was longer,the difference between the two groups was statistically significant.(P<0.05).There was no statistically significant difference between the two groups of intraoperative hemorrhage volume,blood white blood cell count on the 1st and 3rd day after operation,postoperative fever rate,and complication rate(P>0.05).5.Pathological indicatorsAll cases in this study were diagnosed as gastric stromal tumors in histopathology and immunohistochemistry after operation.The positive rates of CD117,CD34,and DOG-1 in the endoscopic group all were 100%,in the surgical group were 96.3%,100%,and 93%respectively.For the tumor risk grade,there were 1 case of high risk and 8 cases of medium risk in the endoscopic group,7 cases of high risk and 20 cases of medium risk in the surgical group,the difference was not statistically significant(P>0.05).6.Follow-up.The average follow-up time of the endoscopic group was 37.0±9.2 months(27-50 months),the follow-up rate was 100%.The average follow-up time of the surgical group was 37.9±15.2 months(27-46 months),5 cases were lost to follow-up,one case died from other diseases,and the follow-up rate was 81.5%.During the follow-up period,no recurrence or metastasis was found in both groups.ConclusionEFTR is safe and effective for the treatment of large gastric stromal tumors with maximum diameter of 5-7 cm.Compared with surgical resection,it has the advantages of less trauma,faster postoperative recovery,and low hospitalization costs.However,how to shorten the operation time is an urgent problem to solve. |
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