Endoscopic vs laparoscopic resection for gastric gastrointestinal stromal tumors: Oncological outcomes

Abstract

BACKGROUND

Surgical resection is the core treatment for localized gastric gastrointestinal stromal tumors (LGISTs). Advances in minimally invasive techniques have led to the use of both endoscopic and laparoscopic resections; however, there is controversy regarding their oncological efficacy and safety, especially due to the lack of head-to-head comparative data with balanced baselines.

AIM

To systematically compare the perioperative outcomes and mid-term oncological efficacy of endoscopic vs laparoscopic resection for LGISTs, and provide an evidence-based reference for clinical surgical approach selection.

METHODS

Patients with LGIST who underwent surgery in our hospital between January 2023 and January 2024 were retrospectively enrolled. After 1:1 propensity score matching, 45 patients who received endoscopic resection were assigned to the endoscopic group, and 45 patients who underwent laparoscopic resection were included in the laparoscopic group. Intraoperative indicators (such as operation time, blood loss, R0 resection rate), postoperative recovery indicators (including hospital stay, time to first flatus), complication rate, and mid-term oncological outcomes [1-year/3-year recurrence-free survival (RFS), overall survival (OS)] were compared between the two groups. Multivariate Cox regression was used to identify prognostic factors.

RESULTS

After matching, the baseline data of the two groups were comparable (P > 0.05). The endoscopic group was superior to the laparoscopic group in terms of operation time [80 minutes (65-100 minutes) vs 95 minutes (80-120 minutes), P = 0.002], intraoperative blood loss [25 mL (15-35 mL) vs 55 mL (40-90 mL), P < 0.001], and postoperative hospital stay [5 days (4-7 days) vs 7 days (6-9 days), P < 0.001]. There were no significant differences in the rates of R0 resection (95.6% vs 97.8%, P = 0.617), intraoperative tumor rupture (2.2% vs 4.4%, P = 1.000), and 30-day postoperative complications (11.1% vs 22.2%, P = 0.152) between the two groups. With a median follow-up of 32 months, the 3-year RFS (93.3% vs 91.1%, P = 0.695) and 3-year OS (97.8% vs 95.6%, P = 1.000) rates were comparable between the two groups. Multivariate analysis showed that tumor size (HR = 1.38, P = 0.002), mitotic count (HR = 1.18, P = 0.010), and National Institutes of Health risk stratification (intermediate risk vs low risk: HR = 5.12, P = 0.001) were independent risk factors for RFS, while surgical approach was not an independent prognostic factor (P = 0.558).

CONCLUSION

In carefully selected LGIST cases, endoscopic resection achieves comparable mid-term oncological efficacy to that of laparoscopic resection, while offering the advantages of shorter operation time, less blood loss, and faster postoperative recovery. It can therefore be a minimally invasive treatment option for eligible patients, with surgical decision-making based on tumor characteristics and multidisciplinary assessments.

Keywords: Endoscopy; Laparoscopy; Localized gastric gastrointestinal stromal tumor; Complications; Prognosis

Core Tip: This study compared the efficacy of endoscopic and laparoscopic resection for localized gastric gastrointestinal stromal tumors (LGISTs) using propensity score matching to control for baseline bias. Endoscopic resection was found to be superior in terms of reduced operation time, blood loss, and postoperative hospital stay, while achieving comparable mid-term oncological outcomes (3-year recurrence-free survival and overall survival) to laparoscopic resection. Tumor size, mitotic count, and National Institutes of Health risk stratification were key factors affecting prognosis, and the surgical approach had no direct influence on recurrence risk. The study provides evidence-based support for “prioritizing minimally invasive endoscopic treatment for carefully selected LGIST patients”.