Endoscopy Dissection Of Stomach Gastrointestinal Stromal Tumor Emerged From The Muscularis Dropria:Analysis Of The Therapeutic Effect

Objective:the purpose of this study is to evaluate the feasibility and safety of endoscopic dissection for stomach gastrointestinal stromal tumor.Method:We retrospectively analyzed133gastric GISTs patients who underwent surgery or endoscopy dissection in the2nd Affiliated Hospital of Zhejiang University, from September2009to December2012, among which open surgery for79patients, laparoscopic surgery for22, and endoscopic dissection of32.121patients were followed up, and the relationship between genders, age, tumor size, mitotic count, risk stratification, the Ki-67expression and prognosis were analyzed. We compared the success rate, operating time, hospitalization period, hospitalization costs, complications, and recurrence rate to evaluate the feasibility and safety of endoscopic dissection for stomach GISTs.Results:The mean age was54.6±11.4ys (range,16-84ys),69male and64 female.121were followed up, the medium follow-up period was27months (range,3-42months),5recurrences were founded, and2died for the disease. Large tumor size, high mitosis count, non-gastric location, high risk stratification, and expression rate of Ki-67were independent adverse prognostic factors (p<0.05). Within the32patients of endoscopy dissection,35lesions was resected,1patient was blooding during operation, and was hemostasis by laparoscope;3patients were perforation during the procedure, and were sutured by metal clip in endoscope;1patient was found perforation by KUB after the procedure, and was success by conservative treatment;33(94.3%) lesions were en-bloc resection. No recurrence or metastasis was found in anyone after endoscopy dissection with follow-up of a medium30months (range,3-42months). Compared with laparoscopic and open surgery, endoscopy dissection has the advantage in operation time (p<0.001) and hospitalization period (p<0.05), the hospitalization costs was less than open surgery (p<0.001), but had no significance with laparoscopic surgery (p>0.05).Conclude:Endoscopy dissection is a safe and feasible technique to resect gastric GISTs and the incidence of complications was low, and has the advantage in operation time and hospitalization period compared with laparoscopic surgery, and has the advantage in operation time, hospitalization period and costs compared with open surgery. Gastric GISTs have low recurrence rate, and expression rate of Ki-67can evaluate the prognoses.