Randomized Controlled Trial
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World J Gastroenterol. Jul 7, 2014; 20(25): 8253-8259
Published online Jul 7, 2014. doi: 10.3748/wjg.v20.i25.8253
Endoscopic full-thickness resection and laparoscopic surgery for treatment of gastric stromal tumors
Liu-Ye Huang, Jun Cui, Cheng-Rong Wu, Bo Zhang, Li-Xin Jiang, Xiang-Shu Xian, Shu-Juan Lin, Ning Xu, Xiao-Ling Cao, Zhi-Hua Wang
Liu-Ye Huang, Jun Cui, Cheng-Rong Wu, Bo Zhang, Li-Xin Jiang, Xiang-Shu Xian, Shu-Juan Lin, Ning Xu, Xiao-Ling Cao, Zhi-Hua Wang, Department of Gastroenterology, Yantai Yu Huang Ding Hospital, Yantai 264000, Shandong Province, China
Li-Xin Jiang, Department of Abdominal Surgery, Yantai Yu Huang Ding Hospital, Yantai 264000, Shandong Province, China
Author contributions: Huang LY, Cui J, Wu CR and Jiang LX designed and initiated the study; Zhang B, Wang ZH and Lin SJ performed the literature search; Xian XS, Xu N and Cao XL performed additional cross searching; Huang LY drafted and wrote the paper; Lin SJ critically revised the paper.
Supported by Natural Science Foundation of Shandong Province, No. ZR2013HM004
Correspondence to: Dr. Shu-Juan Lin, Department of Gastroenterology, Yantai Yu Huang Ding Hospital, East Road No. 20, Zhifu District, Yantai 264000, Shandong Province, China. sdlsj123@126.com
Telephone: +86-535-6691999 Fax: +86-535-6240341
Received: January 16, 2014
Revised: March 17, 2014
Accepted: April 8, 2014
Published online: July 7, 2014
Processing time: 167 Days and 17.8 Hours
Abstract

AIM: To assess the effectiveness of endoscopic full-thickness resection (EFR) and laparoscopic surgery in the treatment of gastric stromal tumors arising from the muscularis propria.

METHODS: Out of 62 gastric stromal tumors arising from the muscularis propria, each > 1.5 cm in diameter, 32 were removed by EFR, and 30 were removed by laparoscopic surgery. The tumor expression of CD34, CD117, Dog-1, S-100, and SMA was assessed immunohistochemically. The operative time, complete resection rate, length of hospital stay, incidence of complications, and recurrence rate were compared between the two groups. Continuous data were compared using independent samples t-tests, and categorical data were compared using χ2 tests.

RESULTS: The 32 gastric stromal tumors treated by EFR and the 30 treated by laparoscopic surgery showed similar operative time [20-155 min (mean, 78.5 ± 30.1 min) vs 50-120 min (mean, 80.9 ± 46.7 min), P > 0.05], complete resection rate (100% vs 93.3%, P > 0.05), and length of hospital stay [4-10 d (mean, 5.9 ± 1.4 d) vs 4-19 d (mean, 8.9 ± 3.2 d), P >0.05]. None of the patients treated by EFR experienced complications, whereas two patients treated by laparoscopy required a conversion to laparotomy, and one patient had postoperative gastroparesis. No recurrences were observed in either group. Immunohistochemical staining showed that of the 62 gastric stromal tumors diagnosed by gastroscopy and endoscopic ultrasound, six were leiomyomas (SMA-positive), one was a schwannoglioma (S-100 positive), and the remaining 55 were stromal tumors.

CONCLUSION: Some gastric stromal tumors arising from the muscularis propria can be completely removed by EFR. EFR could likely replace surgical or laparoscopic procedures for the removal of gastric stromal tumors.

Keywords: Gastric stromal tumors; Treatment; Endoscopy; Muscularis propria; Full-thickness resection

Core tip: We used endoscopic full-thickness resection (EFR) to remove gastric stromal tumors arising from the muscularis propria. Out of 62 gastric stromal tumors, each > 1.5 cm in diameter, we found that the 32 gastric stromal tumors treated by EFR and the 30 treated by laparoscopic surgery showed similar operative time and complete resection rate. None of the patients treated by EFR experienced complications, whereas two patients treated by laparoscopy required a conversion to laparotomy and one patient had postoperative gastroparesis. No recurrences were observed in either group. EFR could replace certain surgical or laparoscopic procedures for the removal of gastric stromal tumors.