Endoscopic super-minimally invasive vs laparoscopic wedge resection for muscularis-propria-originating extraluminal gastric tumors: Efficacy and selection

Abstract

BACKGROUND

Gastric tumors originating from the muscularis propria layer, particularly those with extraluminal growth, pose therapeutic challenges because treatment must balance complete resection with preservation of gastric integrity. Although both digestive endoscopic super-minimally invasive surgery (DESMIS) and laparoscopic wedge resection (lap MWR) are increasingly used, objective preoperative criteria to guide selection between these approaches remain unclear.

AIM

To target observable preoperative indicators and compare the efficacy of DESMIS and Lap MWR for treating EGT-MP, aiming to guide optimal treatment plan selection for such tumors at different locations.

METHODS

Patients who underwent DESMIS or Lap MWR for EGT-MP at the First Medical Center of Chinese People’s Liberation Army General Hospital between January 2019 and December 2023 were retrospectively selected. Basic patient information, surgical, health economics, and efficacy evaluation indicators; pathological types; postoperative medical management; and laboratory tests were recorded. They were categorized into the endoscopic full-thickness resection, submucosal tunneling endoscopic resection (STER), and laparoscopic minimally invasive surgery (LMIS) groups for intergroup comparisons.

RESULTS

Overall, 542 patients were included in the study, with 98, 99, and 345 in the endoscopic full-thickness resection, submucosal tunneling endoscopic resection, and LMIS groups, respectively. The LMIS group had larger tumor sizes within the EGT-MP, longer operative times, greater blood loss, longer hospital stays, higher surgical costs, lower incidence of postoperative adverse reaction, shorter duration of proton pump inhibitor (PPI), less frequent use of PPI infusion therapy, a shorter antimicrobial treatment duration, fewer patients requiring escalation to higher-level antibiotics, and a shorter time to resume oral intake than the other groups. Lap MWR resulted in a greater preoperative decrease in hemoglobin levels, a lower postoperative level of white blood cell and C-reactive protein, and a greater increase in alanine and aspartate aminotransferase levels from preoperative values than DESMIS. When analyzing by tumor location, Lap MWR for EGT-MP in the stomach did not result in longer operative times, surgical costs, or hospital stays compared with DESMIS. However, the duration of PPI use was shorter, the method of PPI administration was simpler, the duration of antimicrobial treatment was shorter, the antibiotic level was lower, and the time to resume oral intake was shorter. DESMIS for EGT-MP in the fundus of the stomach had shorter operative times, less blood loss, and lower surgical costs compared with Lap MWR. However, the duration of nasogastric tube placement and antimicrobial treatment was not longer.

CONCLUSION

DESMIS provides several advantages for EGT-MP, achieving surgical outcomes comparable to those of Lap MWR while yielding better health economics benefits. Our findings suggest that Lap MWR and DESMIS are more advantageous for EGT-MP in the antrum and fundus of the stomach, respectively.

Keywords: Stomach neoplasms; Endoscopic mucosal resection; Laparoscopes; Minimally invasive surgical procedures; Treatment outcome

Core Tip: This study compared digestive endoscopic super minimally invasive surgery and laparoscopic wedge resection (Lap MWR) for treating extraluminal gastric tumors originating from the muscularis propria layer (EGT-MP). Analysis of 542 patients revealed that the Lap MWR group had larger tumors, longer operative times, greater blood loss, longer hospital stays, and higher costs, but a lower incidence of adverse postoperative reactions and a simpler medication regimen. Outcomes were location-dependent. For antral EGT-MP, Lap MWR did not prolong surgery or hospitalization and simplified postoperative management. For fundic EGT-MP, digestive endoscopic super minimally invasive surgery provided shorter operative times, less blood loss, and lower costs.