Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Rd, Hangzhou, Zhejiang Province, 310003, China.
Department of Gastroenterology, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Rd, Hangzhou, Zhejiang Province, 310003, China.
Surg Endosc. 2020 Sep;34(9):4053-4064. doi: 10.1007/s00464-019-07311-x. Epub 2020 Feb 3.
Endoscopic full-thickness resection (EFTR) has been increasingly applied in the treatment of gastric submucosal tumors (G-SMTs) with explorative intention. This study aimed to compare the efficacy, tolerability, and clinical outcomes of EFTR and surgical intervention for the management of muscularis propria (MP)-derived G-SMTs.
Between September 2011 and May 2019, the clinical records of patients with MP-derived G-SMTs undergoing EFTR at our endoscopic unit were collected. A cohort of people with primary MP-derived G-SMTs treated by surgery was matched in a 1:1 ratio to EFTR group with regard to patients' baseline characteristics, clinicopathologic features of the tumor and the procedure date. The perioperative outcomes and follow-up data were analyzed.
In total, 62 and 62 patients were enrolled into the surgery and EFTR group, respectively, with median follow-up of 786 days. The size of G-SMTs (with ulceration) ranged from 10 to 90 mm. For patients with tumor smaller than 30 mm, surgery and EFTR group presented comparable procedural success rate (both were 100%), en bloc resection rate (100% vs. 94.7%), tumor capsule rupture rate (0% vs. 5.3%), and pathological R0 resection rate (both were 100%). EFTR had a statistically significant advantage over surgery for estimated blood loss (3.12 ± 5.20 vs. 46.97 ± 60.73 ml, p ≤ 0.001), discrepancy between the pre- and postprocedural hemoglobin level (5.18 ± 5.43 vs. 9.84 ± 8.25 g/L, p = 0.005), bowel function restoration [1 (0-5) vs. 3 (1-5) days, p ≤ 0.001], and hospital cost (28,617.09 ± 6720.78 vs. 33,963.10 ± 13,454.52 Yuan, p = 0.033). The patients with tumor larger than 30 mm showed roughly the same outcomes after comparison analysis of the two groups. However, the clinical data revealed lower en bloc resection rate (75.0% vs. 100%, p = 0.022) and higher tumor capsule rupture rate (25.0% vs. 0%, p = 0.022) for EFTR when compared to surgery. The procedure time, duration of postprocedural fasting and antibiotics usage, and hospital stay of the two groups were equivalent. The occurrence rate of adverse events within postoperative day 7 were 74.2% and 72.6% after EFTR and surgery, respectively (p = 1.000). No complications occurred during the follow-up.
For treatment of MP-derived G-SMTs (with or without ulceration), our study showed the feasibility and safety of EFTR, which also provided better results in terms of procedural blood loss, the postoperative bowel function restoration and cost-effectiveness when compared to surgery, whereas the surgery was superior in en bloc resection rate for G-SMTs larger than 30 mm. The postprocedural clinical outcomes seemed to be equivalent in these two resection methods.
内镜全层切除术（EFTR）已越来越多地用于具有探索性意图的胃黏膜下肿瘤（G-SMT）的治疗。本研究旨在比较 EFTR 与手术干预治疗源于固有肌层（MP）的 G-SMT 的疗效、耐受性和临床结果。
在 2011 年 9 月至 2019 年 5 月期间，收集了在我们内镜单位接受 MP 来源的 G-SMT 行 EFTR 治疗的患者的临床记录。通过 1:1 比例的患者基线特征、肿瘤的临床病理特征和手术日期，与 EFTR 组相匹配，匹配了一组接受手术治疗的原发性 MP 来源的 G-SMT 患者。分析了围手术期结果和随访数据。
共纳入 62 例接受手术和 EFTR 治疗的患者，中位随访时间为 786 天。G-SMT 的大小（伴溃疡）范围为 10 至 90mm。对于肿瘤小于 30mm 的患者，手术和 EFTR 组的手术成功率（均为 100%）、整块切除率（均为 100%）、肿瘤包膜破裂率（0%比 5.3%）和病理 R0 切除率（均为 100%）相当。EFTR 在估计出血量（3.12±5.20 比 46.97±60.73ml，p≤0.001）、血红蛋白水平术前与术后差值（5.18±5.43 比 9.84±8.25g/L，p=0.005）、肠功能恢复[1（0-5）比 3（1-5）天，p≤0.001]和住院费用（28617.09±6720.78 比 33963.10±13454.52 元，p=0.033）方面明显优于手术。两组比较发现，肿瘤大于 30mm 的患者的结果大致相同。然而，EFTR 的整块切除率（75.0%比 100%，p=0.022）和肿瘤包膜破裂率（25.0%比 0%，p=0.022）低于手术。两组的手术时间、术后禁食和抗生素使用时间以及住院时间相当。EFTR 和手术治疗后 7 天内的不良事件发生率分别为 74.2%和 72.6%（p=1.000）。随访期间无并发症发生。
对于源于固有肌层（伴或不伴溃疡）的 G-SMT 的治疗，本研究表明 EFTR 是可行且安全的，与手术相比，EFTR 在手术出血量、术后肠功能恢复和成本效益方面具有更好的效果，而手术在大于 30mm 的 G-SMT 的整块切除率方面更具优势。这两种切除方法的术后临床结果似乎相当。
