Wang Yong-Qing, Li Long-Quan, Li Guang-Ming
Day Diagnostic Center, Gansu Provincial Hospital, Lanzhou, China.
Hepatology Department, Lanzhou University Second Hospital, Lanzhou, China.
J Gastrointest Oncol. 2022 Dec;13(6):2863-2873. doi: 10.21037/jgo-22-1121.
There are still clinical controversy on the efficacy and safety of endoscopic resection (ER) and laparoscopic resection (LR) in the treatment of gastrointestinal stromal tumors (GISTs). The present study aimed to evaluate the safety and efficacy of ER in the treatment of GISTs by comparing the relative outcomes of ER to LR.
PubMed, Web of Science, Cochrane Library, and Embase were searched. Data were retrieved from January 2010 to January 2020 and subjected to a meta-analysis based on the intraoperative and postoperative outcomes of ER and LR. The intervention arm was treated by LR while the comparator arm was treated by ER. Relevant literature was selected based on the inclusion criteria, data was extracted, and quality evaluation of the included literature was carried out. The Newcastle-Ottawa Scale (NOS) was applied for assessing the quality of included studies. Heterogeneity between studies was assessed using the Cochrane χ test and I statistic, and Funnel plots and Egger's test were used to detect publication bias.
The present analysis included 13 studies, comprising a total of 1,261 patients, (ER LR: 543 718). The incidence rate of postoperative complications [odds ratio (OR), 0.400; P=0.001] was significantly lower in the ER group [3.3%; 95% confidence interval (CI), 0.015 to 0.055] than the LR group (8.9%; 95% CI, 0.03 to 0.17). The meta-analysis revealed that the recurrence rate following ER (1.7%; 95% CI, 0.005 to 0.033) was lower than that following LR (2.5%; 95% CI, 0.012 to 0.041). The R0 resection rate of ER (99%; 95% CI, 0.975 to 0.999) was similar to that of LR (100%; 95% CI, 0.995 to 1.000). No publication bias in this study (P>0.10), and the sensitivity analysis showed that the study was robust.
ER was safer and more efficient than LR in terms of all the outcomes, except the R0 resection rate. Thus, ER should be considered the treatment of choice. However, attention should be paid to the surgical margin status following ER.
内镜切除术（ER）和腹腔镜切除术（LR）治疗胃肠道间质瘤（GIST）的疗效和安全性在临床上仍存在争议。本研究旨在通过比较ER与LR的相关结果来评估ER治疗GIST的安全性和疗效。
检索了PubMed、Web of Science、Cochrane图书馆和Embase。检索2010年1月至2020年1月的数据，并根据ER和LR的术中及术后结果进行荟萃分析。干预组采用LR治疗，对照组采用ER治疗。根据纳入标准选择相关文献，提取数据，并对纳入文献进行质量评估。采用纽卡斯尔-渥太华量表（NOS）评估纳入研究的质量。使用Cochrane χ检验和I统计量评估研究间的异质性，并用漏斗图和Egger检验检测发表偏倚。
本分析纳入13项研究，共1261例患者（ER组543例，LR组718例）。ER组术后并发症发生率[比值比（OR），0.400；P = 0.001]显著低于LR组[3.3%；95%置信区间（CI），0.015至0.055]（8.9%；95%CI，0.03至0.17）。荟萃分析显示，ER术后复发率（1.7%；95%CI，0.005至0.033）低于LR术后复发率（2.5%；95%CI，0.012至0.041）。ER的R0切除率（99%；95%CI，0.975至0.999）与LR的R0切除率（100%；95%CI，0.995至1.000）相似。本研究无发表偏倚（P>0.10），敏感性分析表明该研究结果可靠。
除R0切除率外，ER在所有结果方面均比LR更安全、更有效。因此，ER应被视为首选治疗方法。然而，ER术后应注意手术切缘情况。
