Published online Aug 27, 2023. doi: 10.4240/wjgs.v15.i8.1629
Peer-review started: April 26, 2023
First decision: May 25, 2023
Revised: June 6, 2023
Accepted: July 4, 2023
Article in press: July 4, 2023
Published online: August 27, 2023
Processing time: 121 Days and 3.3 Hours
With recent advancements in endoscopic and laparoscopic management of gastric subepithelial tumors (SETs), different approaches to minimally invasive surgery have been adopted to improve the clinical outcomes.
To treat gastric SETs, the effectiveness and safety of endoscopic resection (ER), laparoscopic resection (LR), or our hybrid method were compared in terms of procedure duration, duration of hospital stay, and major complications.
This retrospective study compared the differences between ER and LR, and between ER with backup surgery and LR, in terms of demographic data, tumor characteristics, and perioperative outcomes. Thus, Goldilocks principle was used to determine the best type of minimally invasive surgery for gastric SETs.
This retrospective review of records was performed on all patients of gastric SETs with high probability of surgical intervention undergoing tumor resection in the operating theater between January 2013 and December 2021. All patients were divided into two groups, either group of ER or group of LR.
Totally, 194 patients were divided into the ER group (n = 100) and LR group (n = 94). In the ER group, 27 patients required backup laparoscopic surgery after an incomplete ER. The patients in the ER group had small tumor sizes and shorter procedure durations while the patient in the LR group had large tumor sizes, exophytic growth, malignancy, and tumors that were more often located in the middle or lower third of the stomach. Both groups had similar durations of hospital stays and a similar rate of major postoperative complications. For the patients in the ER group who underwent backup surgery required longer procedures (56.4 min) and prolonged stays (2 d) compared to the patients in the LR group without the increased rate of major postoperative complications. The optimal cut-off point for the tumor size for laparoscopic surgery was 2.15 cm.
ER was indicated for a smaller tumor and intraluminal growth, whereas LR was indicated for a larger tumor (optimal cut-off point: 2.15 cm), tumors located in the middle or lower third of the stomach, exophytic growth, and more aggressive malignancy behavior. Backup surgery is preserved for incomplete ER to effectively reduce associated morbidities.
Multidisciplinary teamwork adopts different strategies to yield the efficient clinical outcome according to the tumor characteristics.