Application Of Component Separation Technique In Laparoscopic Gastric Stromal Tumor Resection

Objective:To compare the clinical efficacy of laparoscopic component separation technique(CST)with traditional laparoscopic surgery(TLS)in the treatment of gastric stromal tumor(GST)and to investigate the feasibility,safety and efficacy of laparoscopic application of component separation technique(CST)in the treatment of gastric stromal tumor(GST).Methods:A single-center retrospective case study was used to retrospectively analyze the clinical data of patients diagnosed with gastric stromal tumor(GST)and treated surgically in the Department of Gastroenterology Surgery of the second hospital of Jilin University between March 2018 and March 2021,and a total of 97 cases were enrolled after screening for inclusion and exclusion criteria.Among them,41 cases were treated by laparoscopic component separation technique(CST group,n=41)and 56 cases were treated by conventional laparoscopic surgery(TLS group,n=56).The baseline data,perioperative indicators,pathological features and immunohistochemical results and follow-up results of the two groups were compared and analyzed using SPSS23.0 statistical software to investigate the clinical efficacy of laparoscopic application of the component separation technique(CST)for the treatment of gastric stromal tumor(GST).Results:1.There were no significant differences between the CST and TLS groups in terms of age,gender,nutritional score,tumor location,tumor growth pattern and first complaint(P >0.05).2.the whole group of GST patients obtained R0 resection.the CST group had faster postoperative recovery and outperformed the TLS group in terms of operative time,intraoperative bleeding,time to first postoperative gas,time to first postoperative fluid intake and postoperative hospital stay(P<0.05).The differences between the two groups were not significant(P>0.05)with regard to the length of the surgical incision and the incidence of postoperative complications.The results of subgroup analysis showed that regarding the favorable locations GST,the TLS group was superior to the CST group in terms of operative time(P<0.05).The differences between the two groups were not significant in terms of intraoperative bleeding,length of surgical incision,time to first postoperative venting,time to first postoperative fluid intake,postoperative hospital stay and postoperative complication rate(P>0.05).Regarding the unfavorable locations GST,the CST group was superior to the TLS group in terms of operative time,intraoperative bleeding,time to first postoperative gas,time to first postoperative fluid intake,and time to postoperative hospitalization compared with the TLS group(P<0.05).There was no significant difference between the two groups in terms of the length of surgical incision and the incidence of postoperative complications(P>0.05).3.The distance from the incision margin to the tumor margin was smaller in the CST group compared with the TLS group(P<0.05).As for the maximum tumor length,tumor cell histomorphology,mitotic index,immunohistochemical results,Ki-67 proliferation index and risk classification,the differences between the two groups were not significant(all P>0.05).Subgroup analysis showed that for the favorable locations GST,there was no significant difference between the two groups in terms of the distance from the cut edge to the tumor margin,maximum tumor length,tumor cell histology,mitotic index,immunohistochemistry results,Ki-67 proliferation index and risk classification(all P>0.05).Regarding the unfavorable locations GST,the distance from the cut edge to the tumor margin was shorter in the CST group compared with the TLS group(P<0.05).As for the the maximum tumor length,tumor cell histomorphology,mitotic index,immunohistochemical results,Ki-67 proliferation index,and risk classification,the differences between the two groups were not significant(all P>0.05).4.A total of 84 patients were all followed up,with a follow-up rate of 87%.The follow-up time of the CST group ranged from 24 to 60 months and that of the TLS group ranged from 24 to 58 months,with no statistical difference between the two groups(independent t-test of the two samples,P=0.579).There was no significant difference between the two groups in terms of long-term tumor efficacy.Conclusions:1.CST is safe and effective in the treatment of gastric mesenchymal tumors,and patients can recover rapidly after surgery,which is in line with the ERAS concept.2.For GST with a diameter of 2-5 cm and located at favorable locations,TLS is more advantageous for the treatment of GST.3.For GST with a diameter of 2-5 cm and located at unfavorable locations,especially GST located in the(near)cardia region and(near)pylorus region,CST can preserve the normal gastric tissues to the maximum extent and can preserve the cardia and pylorus of the stomach,and can replace laparoscopic proximal gastrectomy,laparoscopic total gastrectomy or laparoscopic distal gastrectomy.