Yin Xiaonan, Yin Yuan, Chen Huijiao, Shen Chaoyong, Tang Sumin, Cai Zhaolun, Zhang Bo, Chen Zhixin
1 Department of Gastrointestinal Surgery, West China Hospital, Sichuan University , Chengdu, China .
2 Department of Pathology, West China Hospital, Sichuan University , Chengdu, China .
J Laparoendosc Adv Surg Tech A. 2018 Jan;28(1):58-64. doi: 10.1089/lap.2017.0305. Epub 2017 Oct 30.
This study aimed to evaluate the safety, feasibility, and prognosis of three different types of minimally invasive procedures for treating gastric gastrointestinal stromal tumors (GISTs) ≤5 cm.
The clinical data, perioperative conditions, and the follow-up results of patients who underwent laparoscopic resection (LAP), laparoscopic and endoscopic cooperative surgery (LECS), or endoscopic submucosal dissection (ESD) for gastric GISTs ≤5 cm were retrospectively collected and analyzed.
A total of 91 patients were enrolled in this study, and the number of cases who underwent LAP, LECS, and ESD was 30, 15, and 46, respectively. Compared with patients in the LAP and LECS group, patients in the ESD group had a smaller tumor size (P < .001, <.05, respectively.) and a higher percentage of intragastric growth pattern (all P value <.01). Significant differences were found in operative time and intraoperative blood loss among the three groups (P < .001). The operative time and intraoperative blood loss in ESD group were significantly less than that in LECS and LAP groups. No statistical difference was found in the postoperative recovery and complications among the three groups, such as nasogastric tube retention, anal exhaust time, oral intake, postoperative complication, and tumor recurrence.
Minimally invasive surgery for gastric GISTs ≤5 cm is safe and feasible. The final choice regarding a minimally invasive approach should be based on the tumor size, tumor location, pattern of tumor growth, and experience of laparoscopic surgeons.
本研究旨在评估三种不同类型的微创手术治疗直径≤5 cm的胃胃肠道间质瘤（GIST）的安全性、可行性及预后。
回顾性收集并分析接受腹腔镜切除术（LAP）、腹腔镜与内镜联合手术（LECS）或内镜黏膜下剥离术（ESD）治疗直径≤5 cm胃GIST患者的临床资料、围手术期情况及随访结果。
本研究共纳入91例患者，接受LAP、LECS和ESD的病例数分别为30例、15例和46例。与LAP组和LECS组患者相比，ESD组患者的肿瘤直径更小（P值分别<0.001、<0.05），胃内生长模式的比例更高（所有P值<0.01）。三组间手术时间和术中出血量存在显著差异（P<0.001）。ESD组的手术时间和术中出血量显著少于LECS组和LAP组。三组在术后恢复及并发症方面，如鼻胃管留置时间、肛门排气时间、经口进食情况、术后并发症及肿瘤复发等，均未发现统计学差异。
直径≤5 cm的胃GIST微创手术安全可行。微创手术方式的最终选择应基于肿瘤大小、肿瘤位置、肿瘤生长模式及腹腔镜外科医生的经验。
