Clinical Study Of Endoscopic Microsurgery And Surgical Resection Of Gastric Stromal Tumors

Objective The purpose of this study is to investigate the safety and feasibility of endoscopic microsurgery and surgical resection of gastric stromal tumors.Methods A total of 85 cases of gastric stromal tumors were diagnosed in the Second Hospital of Anhui Medical University from June 2013 to October 2017.They were divided into endoscopic resection group(n = 23)and surgical resection group(n = 62).The general data,clinical manifestations,endoscopic and radiological examination,pathology and immunohistochemistry of the patients were retrospectively analyzed.The complete resection rate,tumor size,location,operation time and complication rate,hospitalization costs were compared between the two groups.Risk was assessed according to the GIST of malignant potential classification standard(improved NIH dangerous grading standard).Differences between the two groups were compared using Chi-square test(Fishers exact probability method)and t test.Results 1.General clinical data Total 85 patients was diagnosis as gastric stromal tumors were enrolled with 34 male and 51 female,average age 51.4±13.5.There was no significant difference in the incidence of men and women.41.2% of patients with abdominal pain or abdominal distension,14.1%found occasionally and 32.9% with bleeding,other rare clinical manifestations accounted for 16.3%.There was no significant difference in age between the two groups,and the symptoms in the surgical group were more obvious.2.Endoscopic and CT examinations combined with postoperative pathology,the accuracy of CT on pathological diagnosis was 85.9%(73/85),the accuracy of MPS was 95.8%(69/72).the rate of MPS combined with CT on determine the growth pattern was 100%(85/85).3.tumor characteristics 40 cases(47.1%)were located in gastric fundus,gastric body 35 cases(41.2%),gastric antrum 7 cases(8.2%),cardia 2 cases(2.4%)and gastric corner 1 case(85%).The tumor diameter in endoscopic resection is range from 0.5cm to 5.0cm,average tumor size is 1.7 ± 1.1cm.Surgical resection group between 1.2cm ~ 14 cm,average size 5.1 ± 2.5cm.The tumor size of endoscopic resection smaller than other group.In the endoscopic surgery group,there were 12 extremely low-risk patients and 11 low-risk patients.In the surgical group,3 were extremely low-risk,34 were low-risk,15 were moderate-risk,and 10 were high-risk.Differences between the two groups were extremely low-risk and high-risk patients.There were significant differences between the two groups in extremely low-risk and high-risk patients(P<0.05).There were no patients in the endoscopic surgery group with high-risk patients.The high-risk patients in the surgical group accounted for 40.4%(25/62).The positive rate of CD117 was 92.9%,and the DOG1 was 91.8%.There was no significant difference between the two groups.The positive rate of DOG1 expression in CD117-negative GIST was 67.7%.4.For endoscopic and surgical comparisons of gastric stromal tumors with a diameter of ?3 cm All patients in this study had complete tumor resection and the pathology suggested a negative margin.The data of patients with tumor diameter ?3cm were selected for comparison.31 patients were included.Endoscopic surgery was performed in 21 cases and surgical operation in 10 cases.There was no significant difference in gender and age of onset between the two groups(P>0.05).The mean diameter of the tumors in the endoscopic surgery group was 1.5±0.7cm,and tthe surgical group was 2.3±0.7cm.There was a statistically significant difference between the two groups in terms of operation time,intraoperative blood loss,postoperative hospital stay,and total hospitalization costs(P<0.05).The success rate of endoscopic surgery was 100%.In the surgical group,there were 2 intraoperative bleedings and 3 intraperitoneal infections.The incidence of surgical complications was 8.1%.All patients had no recurrence or metastasis during follow-up period.Conclusion There was no difference in the incidence of gastric stromal tumors between men and women.The incidence was high in middle-aged and elderly patients.The clinical features were not specific,and larger patients were more likely to have clinical symptoms.The combined detection of MPS and CT can accurately determine the pathology and growth pattern of the tumor before surgery,and play an important role in the selection of surgical methods.For gastric stromal tumors with a diameter of ?3cm,endoscopic resection is safe and effective compared with surgery.The operation takes a short time,loss blood during surgery,postoperative recovery,low hospitalization costs,small surgical trauma,and the curative effect is significant,worthy of clinical promotion.On the basis of skilled operation,endoscopic microsurgery can also be performed for gastric stromal tumors with a diameter between 3 and 5 cm,but more data are needed to support.