| Background and aims:Endoscopic resection is increasingly performed for gastric gastrointestinal stromal tumors(GIST).However,the safety and efficacy remain controversial,especially for no exact definition of the size of resectable tumors.We aimed in this retrospective study to compare operative complications and prognosis between endoscopically and surgically resected small(≤ 5 cm)GIST tumor groups;and compare the therapeutic effect and economic benefit among three different endoscopic approaches.Methods:We retrospectively analyzed the clinical and pathological data of 409 cases of gastric GISTs who diagnosed by pathology and inmmunohistochemistry in the Nanjing Drum Tower Hospital affiliated to Nanjing University Medical School over the period from February 2009 to September 2017.In this single-center retrospective study,we compared demographics and clinical outcomes and the R0 resection rate between the endoscopy(n=268)and surgery(n=141)groups.Only 409 patients which GIST tumors in size of<5.0 cm were recruited for this comparison study,and analyzed the therapeutic effect among three different endoscopic approaches.Results:Among the 409 patients,there were 243 females and 166 males,the male-female ratio was 0.68.The mean age of patients was 59.0±9.8years(range:31.0-83.0).The most common site of GIST was,in a descending order,the gastric fundus(55%),corpus(27.6%),cardia(10.8%),antrum(6.6%);The R0 resection rate and hospital costs was no statistically significant among the EFTR、STER and ESE group(P>0.05);Compared with the other group,post-resection time to first fluids diet was significantly longer in the EFTR group(2.53± 1.39 days,compared to 1.75±0.75 days in the STER group and 1.64±0.82 days in the ESE group,P<0.001);postoperative hospital stay was significantly longer in the EFTR group(5.25± 1.64 days,compared to 4.42±0.79 days in the STER group and 4.35± 1.42 days in the ESE group,P<0.001)。Compared with the surgery group,GIST tumors in the endoscopy group was significantly smaller(1.69±0.9 cm,compared to 3.20± 1.2 cm in the surgery group;P<0.001)in size;postoperative hospital stay was significantly shorter(4.66±1.5 days,compared to 8.11 ±5.0;P<0.001);post-resection time to first fluids diet was significantly shorter(1.94±1.1 days,compared to 4.63±2.6;P<0.001);incidence of operative and post-operative complications was significantly fewer(p<0.05),and hospital costs were significantly lower(20115.4±5113.5￥compared to43378.4± 16795.7￥;P<0.001).The R0 resection rate was significantly lower in the endoscopy(93.3%)than in the surgery(99.3%)groups(P<0.01).According to the NIH risk classification,in the endoscopy group,176(65.7%),69(25.7%),14(5.2%),9(3.4%)patients were found to be very low、low、intermediate and high risk,respectively.In contrast,27(19.2%),86(61.0%),15(10.6%),13(9.2%)patients were found to be very low、low、intermediate and high risk in the surgery group,respectively(P<0.001).Among 409 cases,51(12.5%)patients were found to be intermediate or high risk.Only 20 patients received adjuvant therapy with imatinib after resection.Eight of the 20 patients took imatinib 1 to 3 months because of its side effects and high costs.However during 33.5 months of follow-up,no local or distant tumor recurrence was observed and two patients were died of other disease in surgery group.Conclusions:Endoscopic resection of selected gastric GISTs(<5cm)is feasible and safe,and is associated with a better intraoperative outcome and an equal postoperative course compared with surgery group. |
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