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

Table 1 Comparison of baseline characteristics between the two groups

Variable	Pre-matching		P value	Post-matching		P value
	Endoscopic (n = 50)	Laparoscopic (n = 73)		Endoscopic (n = 45)	Laparoscopic (n = 45)
Demographic data
Age (years)	57.9 ± 10.1	59.8 ± 9.7	0.285	58.5 ± 9.8	58.9 ± 10.2	0.841
Gender (male)	28 (56.0)	40 (54.8)	0.892	25 (55.6)	24 (53.3)	0.829
BMI (kg/m2)	23.8 ± 2.9	24.3 ± 3.1	0.341	24.0 ± 2.8	24.1 ± 3.0	0.867
Tumor characteristics
Tumor size (cm)	2.8 (2.0-3.8)	4.3 (3.0-5.8)	< 0.001	3.5 (2.6-4.4)	3.6 (2.7-4.5)	0.723
Mitotic count (/50 HPF)	2 (1-4)	4 (2-6)	0.003	3 (1-5)	3 (2-5)	0.435
NIH risk stratification
Very low/low risk	35 (70.0)	38 (52.1)	0.009	28 (62.2)	26 (57.8)	0.654
Intermediate risk	15 (30.0)	35 (47.9)		17 (37.8)	19 (42.2)
Tumor location
Favorable sites	38 (76.0)	30 (41.1)	< 0.001	23 (51.1)	23 (51.1)	1
Unfavorable sites	12 (24.0)	43 (58.9)		22 (48.9)	22 (48.9)
Growth pattern
Intraluminal	35 (70.0)	35 (47.9)	0.002	25 (55.6)	23 (51.1)	0.832
Exophytic	15 (30.0)	38 (52.1)		20 (44.4)	22 (48.9)

Data were showed as n (%) or mean ± SD or median (interquartile range). BMI: Body mass index; NIH: National Institutes of Health; HPF: High-power field.

Table 2 Comparison of perioperative outcomes between the two groups

Variable	Endoscopic (n = 45)	Laparoscopic (n = 45)	Test statistic	P value
Overall comparison
Operation time (minute)	80 (65-100)	95 (80-120)	Z = -3.112	0.002
Intraoperative blood loss (mL)	25 (15-35)	55 (40-90)	Z = -5.421	< 0.001
R0 resection rate	43 (95.6)	44 (97.8)	Fisher	0.617
Intraoperative tumor rupture	1 (2.2)	2 (4.4)	Fisher	1.000
Postoperative hospital stays (days)	5 (4-7)	7 (6-9)	Z = -4.225	< 0.001
Postoperative complications (Clavien-Dindo ≥ II)	5 (11.1)	10 (22.2)	χ2 = 2.051	0.152
Subgroup analysis by location
Favorable sites	n = 23	n = 23
Operation time (minute)	75 (60-90)	85 (70-100)	Z = -2.315	0.021
Intraoperative blood loss (mL)	20 (10-30)	50 (35-70)	Z = -4.521	< 0.001
Unfavorable sites	n = 22	n = 22
Operation time (minute)	90 (75-110)	110 (95-135)	Z = -2.987	0.003
Intraoperative blood loss (mL)	30 (20-45)	65 (50-105)	Z = -4.678	< 0.001
Subgroup analysis by growth pattern
Intraluminal	n = 25	n = 23
Operation time (minute)	70 (55-85)	90 (75-105)	Z = -3.224	0.001
Exophytic	n = 20	n = 22
Operation time (minute)	95 (80-115)	100 (85-125)	Z = -0.912	0.362

Data were showed as n (%) or median (interquartile range).

Table 3 Comparison of postoperative complications between the two groups, n (%)

Complication type & management	Total (n = 90)	Endoscopic (n = 45)	Laparoscopic (n = 45)	P value
Overall complications (Clavien-Dindo ≥ II)	15 (16.7)	5 (11.1)	10 (22.2)	0.152
By grade
Grade II	10 (11.1)	4 (8.9)	6 (13.3)	0.506
Grade IIIa	4 (4.4)	1 (2.2)	3 (6.7)	0.617
Grade IIIb	1 (1.1)	0 (0.0)	1 (2.2)	1.000
Grade IV-V	0 (0.0)	0 (0.0)	0 (0.0)	-
By type
Bleeding - endoscopic hemostasis/transfusion	6 (6.6)	2 (4.4)	4 (8.8)	0.398
Perforation/fistula - conservative treatment/aspiration drainage	3 (3.3)	1 (2.2)	2 (4.4)	1.000
Intra-abdominal infection - antibiotics/aspiration drainage	3 (3.3)	2 (4.4)	1 (2.2)	1.000
Pulmonary infection - antibiotic treatment	4 (4.4)	1 (2.2)	3 (6.7)	0.617
Others	1 (1.1)	0 (0.0)	1 (2.2)	1.000

P values were derived from χ² tests or Fisher's exact tests. One patient may have more than one complication.

Table 4 Comparison of survival outcomes between the two groups

Survival outcome	Endoscopic (n = 45)	Laparoscopic (n = 45)	Test statistic	P value
Median follow-up (months)	32 (26-38)	32 (26-38)	-	0.935
Recurrence events, n (%)	3 (6.7)	4 (8.9)	-	0.695
Death events, n (%)	1 (2.2)	2 (4.4)	-	1.000
RFS rate (%)
1-year	100	100	χ2 = 0.152	0.695
3-year	93.3	91.1
OS rate (%)
1-year	100	100	χ2 = 0.000	0.991
3-year	97.8	95.6

Survival rates were calculated using the Kaplan-Meier method. P values were derived from log-rank tests. RFS: Recurrence-free survival; OS: Overall survival.

Table 5 Multivariate Cox regression analysis of factors associated with recurrence-free survival

Variable	HR	95%CI	P value
Surgical approach (laparoscopic vs endoscopic)	1.32	0.52-3.35	0.558
Age (per 1-year increase)	1.01	0.96-1.07	0.668
Tumor size (per 1-cm increase)	1.38	1.12-1.70	0.002
Mitotic count (per 1 increase/50 HPF)	1.18	1.04-1.34	0.010
NIH risk stratification (intermediate vs low)	5.12	1.88-13.93	0.001
Tumor location (unfavorable vs favorable)	1.65	0.60-4.52	0.328

The model was adjusted for surgical approach, age, tumor size, mitotic count, National Institutes of Health risk stratification, and tumor location. NIH: National Institutes of Health; HPF: High-power field.