Published online Mar 7, 2021. doi: 10.3748/wjg.v27.i9.854
Peer-review started: November 28, 2020
First decision: January 17, 2021
Revised: January 23, 2021
Accepted: February 11, 2021
Article in press: February 11, 2021
Published online: March 7, 2021
Processing time: 94 Days and 23.9 Hours
For gastrointestinal stromal tumors (GISTs) at the esophagogastric junction (EGJ) involving the Z-line, previous proximal gastrectomy (PG) results in serious postoperative reflux and poor quality of life.
To explore and improve the surgical methods of GIST in this part, so as to preserve the cardiac sphincter as much as possible and reduce the incidence of postoperative reflux esophagitis.
We aimed to describe a novel technique to achieve R0 resection of EGJ-GIST involving Z-line with preservation of the sphincter function. We have also compared the outcomes of conformal resection with PG.
In this study, 43 patients having GISTs involving Z-line were included. The perioperative outcomes of patients receiving conformal resection (CR) (n = 18) was compared with that of PG (n = 25). The data of the patients collected were as follows: Clinical and pathologic findings, intra-operative and postoperative outcomes, esophageal 24-h pH parameters, the 36-item short-form health survey, and disease-free survival.
CR was successfully performed in all the patients with negative microscopic margins. The mean operative time, time to first passage of flatus, and postoperative hospital stay was significantly shorter in CR group (P < 0.05), while the intraoperative blood loss was similar in the two groups. The postoperative gastroesophageal reflux as diagnosed by esophageal 24-h pH monitoring and quality of life at 3 mo were significantly in favor of CR compared to PG (both P < 0.001). The 5-year disease-free survival between the two groups were similar (P = 0.163). The cut- off value for the determination of CR or PG was 7.0 mm above the Z-line (83.33% sensitivity, 84.00% specificity, 83.72% accuracy).
CR is safe and feasible for EGJ-GIST located within 7.0 mm above the Z-line. CR was associated with lower incidence of postoperative GER and better quality of life with similar oncological outcomes compared to PG.
Our surgical team will continue to conduct survival follow-up for enrolled patients and cooperate with multiple centers to explore further the advantages and disadvantages of this surgical approach.