Comparison Of Of Endoscopic Full-thickness Resection And Surgery For The Treatment Of Extraluminal Gastric Gastrointestinal Stromal Tumors

Background:Gastrointestinal stromal tumors(GISTs)comprise a fifth of soft-tissue sarcomas.Gastrointestinal stromal tumors can occur at any age without sex predilection.GISTs are most common occurring in the stomach.The traditional surgery(laparoscopic surgery and open surgery)and endoscopic resection are two common ways to resect gastric GISTs.Endoscopic resection is mini-invasive and convenient to achieve a complete resection of the tumors smaller than 5cm and endoscopic resection techniques have been highly developed in recent years.Generally,endoscopic resection is fit for the treatment of intraluminal tumors,while surgery is proper for extraluminal tumors.The technique EFR(endoscopic full-thickness resection)has achieved the endoscopic treatment of extraluminal tumors.However,the treatment efficacy and outcomes of EFR for gastric GISTs are still controversial.Hence,it is necessary to compare the safety and feasibility of endoscopic resection with those of surgery for extraluminal gastric GISTs.Purpose:Our research aimed to analysis the therapeutic effect of different ways of treatments(EFR,laparoscopic surgery and open surgery)for patients with extraluminal gastric GISTs smaller than 5 cm.Thus,we can provide an evidence for the treatment of gastric GISTs.Methods:66 cases of patients with extraluminal gastric GISTs smaller than 5 cm underwent EFR or surgery operation(laparoscopic surgery and open surgery)in our center were analyzed retrospectively.The comparison of the demographics characteristics(age,sex and complications),intraoperative indicators(operation time,amount of bleeding,and the rate of complete resection)and postoperative condition in different groups was made.The size and location of the tumors were also recorded.Results:By analyzing the baseline data,we found that there was no statistical difference between the groups about age,sex or complications.However,the size of the tumors of EFR group was smaller than those of laparoscopic surgery group and open surgery group.The covariance analysis results showed that when comparing with the other two ways of surgery EFR has the advantages of less time consumption and less bleeding during the operation regardless of the tumor size.Besides,EFR can achieve a comparable level in complete resection rate and adverse events rate,and a similar post-operative condition and hospitalization time.Furthermore,there’s no need of routine abdominal drainage for patients of EFR group.Based on location,the cases of laparoscopic surgery group were classified as easy-to-access and difficult-to-access according to the location of tumors.Our record showed that the operation time,the amount of bleeding during surgry and other indexes after operation of the two groups were similar.Based on time,the cases of EFR group are divided into 3 groups according to operational experiences of the doctors.The indexes during and after operation did not influenced by operator experience.Conclusions:For extraluminal gastric GISTs smaller than 5 cm,EFR can achieve a similar curative effect as laparoscopic surgery and open surgery and has the advantages of time saving,mini-invasive,few complication and quick healing.EFR are worth being further applied for the resection of gastric gastrointestinal stromal tumors smaller than 5 cm.