Shen Chaoyong, Chen Haining, Yin Yuan, Chen Jiaju, Han Luyin, Zhang Bo, Chen Zhixin, Chen Jiaping
From the Department of Gastrointestinal Surgery (CS, HC, YY, JC, BZ, ZC, JC); and Intensive Care Unit (LH), West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Medicine (Baltimore). 2015 Jan;94(1):e376. doi: 10.1097/MD.0000000000000376.
Endoscopic resection has been performed to treat small gastric neoplasms. However, this technique for small gastric gastrointestinal stromal tumors (GISTs) remains controversial. This study aims to compare the safety and surgical outcomes of endoscopic versus open resection of small gastric GISTs.The medical records of 54 consecutive gastric GISTs patients with tumor size of ≤2 cm, who were surgically treated with endoscopic resection (endoscopic group) or open surgery (laparotomy group) in a single institution from March 2010 to June 2014, were retrospectively analyzed. The clinical and tumor characteristics, surgical safety, and tumor-related outcomes were evaluated.Of 54 patients, 32 and 22 patients underwent endoscopic resection and laparotomy, respectively. Patients who underwent endoscopic resection yielded a significantly shorter hospital stay compared with patients who underwent laparotomy (P < 0.001). Compared with patients in the endoscopic group, patients in the laparotomy group had more intraoperative blood loss (P < 0.001), had longer nasogastric tube retention (P < 0.001), and required longer operative time (P < 0.001). More laparotomy patients required postoperative analgesic drugs than those in the endoscopic group (n = 9 vs 4; P = 0.016). Gastric perforation occurred in 1 case during operation in the endoscopic group. Patients who underwent these 2 procedures did not differ with respect to tumor size (P = 0.168), perioperative transfusion (P = 1.000), reoperation (P = 1.000), early satiety (P = 0.560), and postoperative bleeding (P = 1.000). With a median follow-up time of 34.5 months, 1 high-risk patient in each group experienced tumor recurrence/metastasis postoperatively.The endoscopic procedure allows safe resection with good surgical outcomes for small gastric GISTs compared with laparotomy. Moreover, larger randomized controlled trials are warranted to confirm endoscopic application for small gastric GISTs.
内镜切除术已被用于治疗小的胃肿瘤。然而，这种治疗小的胃胃肠道间质瘤（GIST）的技术仍存在争议。本研究旨在比较内镜切除与开放切除小的胃GIST的安全性和手术效果。回顾性分析了2010年3月至2014年6月在单一机构接受内镜切除（内镜组）或开放手术（剖腹手术组）治疗的54例连续胃GIST患者的病历，肿瘤大小均≤2厘米。评估了临床和肿瘤特征、手术安全性以及与肿瘤相关的结果。54例患者中，分别有32例和22例接受了内镜切除和剖腹手术。与接受剖腹手术的患者相比，接受内镜切除的患者住院时间明显缩短（P<0.001）。与内镜组患者相比，剖腹手术组患者术中失血量更多（P<0.001），鼻胃管留置时间更长（P<0.001），手术时间更长（P<0.001）。剖腹手术患者术后需要镇痛药的人数比内镜组更多（n = 9比4；P = 0.016）。内镜组手术中有1例发生胃穿孔。接受这两种手术的患者在肿瘤大小（P = 0.168）、围手术期输血（P = 1.000）、再次手术（P = 1.000）、早饱（P = 0.560）和术后出血（P = 1.000）方面没有差异。中位随访时间为34.5个月，每组各有1例高危患者术后出现肿瘤复发/转移。与剖腹手术相比，内镜手术对小的胃GIST能进行安全切除且手术效果良好。此外，需要更大规模的随机对照试验来证实内镜在小的胃GIST中的应用。
