Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2024; 16(12): 3694-3702
Published online Dec 27, 2024. doi: 10.4240/wjgs.v16.i12.3694
Comparison of endoscopic and laparoscopic resection of gastric gastrointestinal stromal tumors: A propensity score-matched study
Bin-Bin Gu, Yan-Di Lu, Jin-Shun Zhang, Zhen-Zhen Wang, Xin-Li Mao, Ling-Ling Yan
Bin-Bin Gu, Zhen-Zhen Wang, Xin-Li Mao, Ling-Ling Yan, Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
Bin-Bin Gu, Zhen-Zhen Wang, Xin-Li Mao, Ling-Ling Yan, Key Laboratory of Minimally Invasive Techniques and Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
Yan-Di Lu, Endoscopic Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
Jin-Shun Zhang, Health Management Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
Author contributions: Gu BB, Zhang JS, Wang ZZ, and Mao XL participated in the clinical treatment; Gu BB and Lu YD wrote the original draft; Yan LL critically revised the manuscript; all of the authors read and approved the final version of the manuscript to be published.
Supported by The Medical Science and Technology Project of Zhejiang Province, China, No. 2024KY1792; The Health Science and Technology Program of Zhejiang Province, China, No. 22PY101; The Program of Taizhou Science and Technology Grant, China, No. 22ywb08 and No. 22ywb09; The Scientific Research Fund Program of Enze Medical Center, China, No. 22EZB12 and No. 22EZC17; and The Open Fund of Key Laboratory of Key Laboratory of Minimally Invasive Techniques and Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, China, No. 21SZDSYS15.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University Institutional Review Board, No. K20220788 and No. K20230163.
Informed consent statement: Given the retrospective nature of the study, a waiver of informed consent form request was granted by the research ethics committee.
Conflict-of-interest statement: The authors declare that they have no conflict of interests to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ling-Ling Yan, MM, Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, No. 150 Xinmen Street, Linhai 317000, Zhejiang Province, China. yanlingling1992@126.com
Received: March 28, 2024
Revised: September 5, 2024
Accepted: September 14, 2024
Published online: December 27, 2024
Processing time: 244 Days and 0.1 Hours
Abstract
BACKGROUND

Endoscopic resection (ER) and laparoscopic resection (LR) have been widely used for the treatment of non-metastatic gastric gastrointestinal stromal tumors (gGISTs) (2-5 cm), but there are no selection criteria for their application.

AIM

To provide a reference for the development of standardized treatment strategies for gGISTs.

METHODS

Clinical baseline characteristics, histopathological results, and short-term and long-term outcomes of patients who treated with ER or LR for gGISTs of 2-5 cm in Taizhou Hospital of Zhejiang Province from January 2014 to August 2022 were retrospectively reviewed. Propensity score matching (PSM) was employed to achieve balance in baseline characteristics of the two groups.

RESULTS

Among 206 patients, 135 were in the ER group and 71 in the LR group. The ER group had significantly smaller tumors [3.5 cm (3.0-4.0 cm) vs 4.2 cm (3.3-5.0 cm), P < 0.001] and different tumor locations (P = 0.048). After PSM, 59 pairs of patients were balanced. After matching, the baseline characteristics of the ER and LR groups did not differ significantly from each other. Compared with LR, ER had faster recovery of diet (P = 0.046) and fewer postoperative symptoms (P = 0.040). LR achieved a higher complete resection rate (P < 0.001) and shorter operation time (P < 0.001). No significant differences were observed in postoperative hospital stay (P = 0.478), hospital costs (P = 0.469), complication rates (P > 0.999), pathological features (mitosis, P = 0.262; National Institutes of Health risk classification, P = 0.145), recurrence rates (P = 0.476), or mortality rates (P = 0.611).

CONCLUSION

Both ER and LR are safe and effective treatments for gGISTs. ER has less postoperative pain and faster recovery, while LR has a higher rate of complete resection.

Keywords: Gastrointestinal stromal tumor; Endoscopic resection; Laparoscopic resection; Propensity score matching; Prognosis; Complete resection

Core Tip: We aimed to compare the outcomes of endoscopic resection (ER) and laparoscopic resection (LR) for 2-5 cm gastric gastrointestinal stromal tumors, with the ultimate goal of informing the development of standardized treatment strategies for these tumors. Propensity score matching was used to minimize selection bias. Notably, ER was associated with reduced postoperative pain and accelerated recovery, positioning it as a favorable option in cases where cosmetic outcomes or organ function preservation are paramount. Conversely, LR demonstrated a superior rate of complete resection, making it the preferred approach for larger tumors.