Chen Liang, Zhang Qiang, Li Feng-Yuan, Yang Li, Zhang Dian-Cai, Wang Lin-Jun, Wang Wei-Zhi, Li Zheng, Xu Jiang-Hao, He Zhong-Yuan, Xu Kang-Jing, Chen Ming, Xu Hao, Xu Ze-Kuan
Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, No.300, Guangzhou Road, Nanjing, Jiangsu province, 210029, China; Department of General Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University,Nanjing, 210009, China.
Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, No.300, Guangzhou Road, Nanjing, Jiangsu province, 210029, China.
Surg Oncol. 2018 Dec;27(4):737-742. doi: 10.1016/j.suronc.2018.10.002. Epub 2018 Oct 2.
Complete surgical resection remains the predominant treatment modality for primary gastrointestinal stromal tumors (GISTs). No therapeutic consensus exists for 2-5 cm gastric GISTs. We compared the efficacy, safety, and prognosis of laparoscopic and endoscopic surgeries in the treatment of relatively small (2-5 cm) intraluminal gastric GISTs.
We collected 101 patients with relatively small intraluminal gastric GISTs who had integrated clinicopathological data and underwent laparoscopic or endoscopic resection (laparoscopic group n = 66; endoscopic group n = 35). Clinicopathological characteristics, perioperative data, and long-term oncological outcomes were retrospectively analyzed. Comparative analysis of clinicopathological data in the two groups was performed by using a chi-square test, Fisher's exact test, and Student's t-test. Recurrence-free survival (RFS) was analyzed by the log-rank test.
All clinicopathological characteristics had no significant difference between the two groups. Patients in the endoscopic group had shorter operation time (P < 0.001), postoperative hospital stay (P < 0.001), time to a liquid diet (P < 0.01), and time to a semi-liquid diet (P < 0.01), and lower hospital charges (P < 0.001), compared to those in the laparoscopic group. Four patients (6.1%) in the laparoscopic group and one patient (2.9%) in the endoscopic group had perioperative complications, but with no significant difference. Recurrence occurred in 6 patients (9.1%) and 2 patients (5.7%) in the laparoscopic and endoscopic groups, respectively. There was no significant difference in RFS between the two groups.
Endoscopic resection is a feasible and safe treatment modality for patients with relatively small (2-5 cm) intraluminal gastric GISTs. Due to faster recovery and lower cost, endoscopic resection is more suitable for elderly and weak patients, or patients with a poor financial situation.
完整手术切除仍然是原发性胃肠道间质瘤（GIST）的主要治疗方式。对于2 - 5厘米的胃GIST，目前尚无治疗共识。我们比较了腹腔镜手术和内镜手术治疗相对较小（2 - 5厘米）腔内胃GIST的疗效、安全性和预后。
我们收集了101例具有完整临床病理资料且接受腹腔镜或内镜切除的相对较小腔内胃GIST患者（腹腔镜组n = 66；内镜组n = 35）。对临床病理特征、围手术期数据和长期肿瘤学结局进行回顾性分析。采用卡方检验、Fisher精确检验和Student t检验对两组临床病理数据进行比较分析。采用对数秩检验分析无复发生存期（RFS）。
两组所有临床病理特征均无显著差异。与腹腔镜组相比，内镜组患者手术时间更短（P < 0.001）、术后住院时间更短（P < 0.001）、开始流食时间更短（P < 0.01）、开始半流食时间更短（P < 0.01），且住院费用更低（P < 0.001）。腹腔镜组4例患者（6.1%）和内镜组1例患者（2.9%）出现围手术期并发症，但差异无统计学意义。腹腔镜组和内镜组分别有6例患者（9.1%）和2例患者（5.7%）复发。两组RFS无显著差异。
内镜切除对于相对较小（2 - 5厘米）腔内胃GIST患者是一种可行且安全的治疗方式。由于恢复更快且成本更低，内镜切除更适合老年体弱患者或经济状况较差的患者。
