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

doi:10.4240/wjgs.v18.i4.116371

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Apr 27, 2026 (publication date) through Apr 24, 2026

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Surg. Apr 27, 2026; 18(4): 116371
Published online Apr 27, 2026. doi: 10.4240/wjgs.v18.i4.116371

Table 1 Basic patient characteristics, n (%)

	EFR group (n = 98)	STER group (n = 99)	LMIS group (n = 345)	F/χ² value	P value
Age	57.7 ± 9.5	48.8 ± 11.2	57.8 ± 12.1	24.72	< 0.001
Male	42 (42.9)	57 (57.6)	180 (52.2)	4.46	0.108
Smoking history	15(15.3)	29 (29.3)	90 (26.1)	6.13	0.047
Alcohol consumption history	22 (22.4)	34 (34.3)	85 (24.6)	4.56	0.103
Cardiovascular disease	38 (38.8)	25 (25.3)	119 (34.5)	4.40	0.111
Diabetes	14 (14.3)	6 (6.1)	37 (10.7)	3.58	0.167
Fatty liver disease	5 (5.1)	15 (15.2)	2 (0.6)	35.78	< 0.001
Anticoagulants used and discontinued for > 7 days	6 (6.1)	3 (3.0)	24 (7.1)	2.16	0.340

EFR: Endoscopic full-thickness resection; STER: Submucosal tunneling endoscopic resection; LMIS: Laparoscopic minimally invasive surgery.

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Table 2 Comparative analysis of surgical indicators, health economics indicators, efficacy evaluation indicators, and postoperative medical management

	EFR group (n = 98)	STER group (n = 99)	LMIS group (n = 345)	H/χ² value	P value
Surgical indicators
Operative times [M (Q1, Q3), minutes]	44.5 (27.0, 78.0)	59.5 (33.0, 91.0)	87.0 (60.0, 115.0)	73.33	< 0.001
Blood loss [M (Q1, Q3), mL]	5.0 (3.0, 8.0)	3.0 (2.0, 5.0)	20.0 (10.0, 50.0)	251.67	< 0.001
Health economics indicators
Hospital stay [M (Q1, Q3), days]	8.0 (7.0, 9.0)	8.0 (7.0, 9.0)	9.0 (7.0, 11.0)	6.53	0.038
Surgical costs [M (Q1, Q3), CNY]	16753.4 (12914.0, 24603.0)	13963.0 (9477.1, 16944.6)	25127.8 (19532.8, 32571.5)	139.62	< 0.001
Surgical costs [M (Q1, Q3), USD]	2435.1 (1877.0, 3576.0)	2029.5 (1377.4, 2462.9)	3652.2 (2839.1, 4734.2)	139.62	< 0.001
Efficacy evaluation indicators
Overall postoperative adverse event incidence, n (%)	34 (34.7)	49 (49.5)	2 (0.6)	171.89	< 0.001
Postoperative abdominal pain incidence, n (%)	13 (13.3)	26 (26.3)	1 (0.3)	81.98	< 0.001
Postoperative fever incidence, n (%)	28 (28.6)	42 (42.4)	0 (0.0)	149.17	< 0.001
Postoperative hematemesis or melena incidence, n (%)	2 (2.0)	2 (2.0)	0 (0.0)	8.15	0.017
Postoperative medical management
Duration of nasogastric tube placement [M (Q1, Q3), days]	0.0 (0.0, 4.0)	0.0 (0.0, 0.0)	1.0 (1.0, 3.0)	89.92	< 0.001
Method of PPI administration, n (%)				117.26	< 0.001
No	1 (1.0)	0 (0.0)	10 (2.9)
Intravenous drip	66 (67.3)	81 (81.8)	335 (97.1)
Intravenous pumping	31 (31.6)	18 (18.2)	0 (0)
PPI use duration [M (Q1, Q3), days]	6.0 (5.0, 7.0)	6.0 (5.0, 7.0)	4.0 (3.0, 5.0)	148.95	< 0.001
Types of anti-infective agents, n (%)				374.83	< 0.001
No	1 (1.0)	0 (0.0)	3 (0.9)
Monotherapy with a first-line or second-line antimicrobial	33 (33.7)	18 (18.2)	332 (96.2)
Combination therapy with metronidazole for anaerobic coverage	47 (48.0)	71 (71.7)	0 (0.0)
Escalation to higher-level antimicrobials	17 (17.3)	10 (10.1)	10 (2.9)
Duration of antimicrobial treatment [M (Q1, Q3), days]	5.0 (4.0, 6.0)	5.0 (4.0, 6.0)	4.0 (3.0, 5.0)	68.45	< 0.001
Time to resume oral intake [M (Q1, Q3), days]	6.0 (5.0, 7.0)	5.0 (4.0, 6.0)	2.0 (1.0, 3.0)	283.10	< 0.001

CNY: Chinese yuan; USD: United States dollar; PPI: Proton pump inhibitor; EFR: Endoscopic full-thickness resection; STER: Submucosal tunneling endoscopic resection; LMIS: Laparoscopic minimally invasive surgery.

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Table 3 Bonferroni post-hoc analysis for controlled pairwise comparisons

	Adjusted P value
	EFR group vs STER group	EFR group vs LMIS group	STER group vs LMIS group
Surgical indicators
Operative times	0.120	< 0.001	< 0.001
Blood loss	0.428	< 0.001	< 0.001
Health economics indicators
Hospital stay	0.355	1.000	0.032
Surgical costs	< 0.001	< 0.001	< 0.001
Postoperative medical management
Duration of nasogastric tube placement	< 0.001	0.547	< 0.001
PPI use duration	0.306	< 0.001	< 0.001
Duration of antimicrobial treatment	0.219	< 0.001	< 0.001
Time to resume oral intake	0.307	< 0.001	< 0.001

EFR: Endoscopic full-thickness resection; STER: Submucosal tunneling endoscopic resection; LMIS: Laparoscopic minimally invasive surgery.

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Table 4 Multiple linear regression analysis

Outcome	Model fit			Surgical approach (vs LMIS)				Significant covariates
Outcome	R²	F	P value		B	95%CI	P value		B	95%CI	P value
Operative time	0.22	25.39	< 0.001	EFR	-11.13	-21.46 to -0.80	0.035	Long-axis diameter of the tumor	9.45	7.52-11.38	< 0.001
Blood loss	0.17	18.41	< 0.001	STER	-12.14	-22.11 to -2.18	0.017	Tumor size	6.25	4.45-8.05	< 0.001
Blood loss	0.17	18.41	< 0.001	STER	-12.14	-22.11 to -2.18	0.017	Alcohol history	9.57	1.87-17.18	0.015
Hospital stay	0.02	2.17	0.045	STER	-1.39	-2.30 to -0.47	0.003	None other
Surgical costs	0.28	28.58	< 0.001	EFR	-6478.55	-9021.72 to -3935.39	< 0.001	Long-axis diameter of the tumor	106.52	25.92-187.12	0.010
Surgical costs	0.28	28.58	< 0.001	STER	-11616.91	-14231.82 to -9002.00	< 0.001	Age	725.34	219.70-1230.98	0.005

CI: Confidence interval; EFR: Endoscopic full-thickness resection; STER: Submucosal tunneling endoscopic resection; LMIS: Laparoscopic minimally invasive surgery.

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Citation: Wang LH, Wu X, Sun YT, Liu PF, Wang JF, Yuan YQ, Li HK, Linghu EQ, Chen QQ. Endoscopic super-minimally invasive vs laparoscopic wedge resection for muscularis-propria-originating extraluminal gastric tumors: Efficacy and selection. World J Gastrointest Surg 2026; 18(4): 116371
URL: https://www.wjgnet.com/1948-9366/full/v18/i4/116371.htm
DOI: https://dx.doi.org/10.4240/wjgs.v18.i4.116371

Wang LH, Wu X, Sun YT, Liu PF, Wang JF, Yuan YQ, Li HK, Linghu EQ, Chen QQ. Endoscopic super-minimally invasive vs laparoscopic wedge resection for muscularis-propria-originating extraluminal gastric tumors: Efficacy and selection. World J Gastrointest Surg 2026; 18(4): 116371 [DOI: 10.4240/wjgs.v18.i4.116371]

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