Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, People's Republic of China.
Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
Surg Endosc. 2020 Jan;34(1):159-169. doi: 10.1007/s00464-019-06744-8. Epub 2019 May 28.
The endoscopic resection of gastrointestinal mesenchymal tumors (GIMTs) is widely accepted because of its minimal invasiveness. However, one major concern is the high rate of positive microscopic margins remaining following endoscopic resection, which was thought to be related to a higher risk of recurrence. This study aimed to determine whether positive margins affect the recurrence rate of gastric GIMTs and the factors associated with positive margins.
Patients with gastric GIMTs were recruited retrospectively from January 2008 to December 2013. Clinical and pathological features, endoscopic procedure information, and follow-up data were collected and analyzed.
The study included 777 patients. All tumors were removed along with the pseudocapsule without macroscopic residual (ER0), and the median tumor size was 15.2 mm (range 3-100 mm). Pathological evaluation revealed 371(47.7%) GISTs. The rate of microscopic R1 resection rate was 47.0% (443/777). In a stepwise multivariate analysis, a significantly increased incidence of R1 resection was recorded for the GISTs (OR 11.13, 95% CI 3.00-41.37). In a subgroup analysis of GISTs, a univariate analysis revealed that EFTR achieved a higher rate of R0 resection (OR 0.56, 95% CI 0.31-1.00), but it was proven insignificant in a stepwise multivariate analysis. Local recurrence occurred in two patients (0.3%) during a mean follow-up time of 34.2 months. Differences in the recurrence rates between the R0 and R1 groups were statistically insignificant (P = 0.841).
R1 resection for gastric GIMTs is not related to a higher recurrence rate than R0 resection, and ER0 resection is sufficient for gastric GIMTs.
内镜下胃肠道间质瘤（GIMTs）切除术因其微创性而被广泛接受。然而，一个主要关注点是内镜切除后残留的微小阳性边缘率较高，这被认为与更高的复发风险有关。本研究旨在确定阳性边缘是否会影响胃 GIMTs 的复发率以及与阳性边缘相关的因素。
回顾性招募了 2008 年 1 月至 2013 年 12 月期间接受胃 GIMTs 治疗的患者。收集并分析了临床和病理特征、内镜手术信息和随访数据。
本研究共纳入 777 例患者。所有肿瘤均沿假包膜完整切除（内镜下完全切除，即 ER0），肿瘤的中位直径为 15.2mm（范围 3-100mm）。病理评估显示 371 例（47.7%）为 GISTs。微观 R1 切除率为 47.0%（443/777）。多因素逐步分析显示，GISTs 的 R1 切除率显著升高（OR 11.13，95%CI 3.00-41.37）。GISTs 的亚组分析显示，单因素分析显示 EFTR 可获得更高的 R0 切除率（OR 0.56，95%CI 0.31-1.00），但多因素逐步分析结果无统计学意义。平均随访 34.2 个月期间，有 2 例（0.3%）患者发生局部复发。R0 组和 R1 组的复发率差异无统计学意义（P=0.841）。
与 R0 切除相比，胃 GIMTs 的 R1 切除并不与更高的复发率相关，并且 ER0 切除对于胃 GIMTs 是足够的。
