Zhao SQ, Wang SY, Ge N, Guo JT, Liu X, Wang GX, Su L, Sun SY, Wang S. Endoscopic full-thickness resection vs surgical resection for gastric stromal tumors: Efficacy and safety using propensity score matching. World J Gastrointest Surg 2025; 17(3): 101002 [DOI: 10.4240/wjgs.v17.i3.101002]
Corresponding Author of This Article
Sheng Wang, MD, Chief Physician, Professor, Department of Gastroenterology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang 110004, Liaoning Province, China. wangs@sj-hospital.org
Research Domain of This Article
Medicine, General & Internal
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Mar 27, 2025; 17(3): 101002 Published online Mar 27, 2025. doi: 10.4240/wjgs.v17.i3.101002
Endoscopic full-thickness resection vs surgical resection for gastric stromal tumors: Efficacy and safety using propensity score matching
Si-Qiao Zhao, Si-Yao Wang, Nan Ge, Jin-Tao Guo, Xiang Liu, Guo-Xin Wang, Lei Su, Si-Yu Sun, Sheng Wang
Si-Qiao Zhao, Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110000, Liaoning, China
Si-Yao Wang, Nan Ge, Jin-Tao Guo, Xiang Liu, Guo-Xin Wang, Lei Su, Si-Yu Sun, Sheng Wang, Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
Co-corresponding authors: Si-Yu Sun and Sheng Wang.
Author contributions: Zhao SQ, Sun SY and Wang S conceptualized and designed the research; Sun SY and Wang S screened patients and acquired clinical data; Liu X, Wang S, Guo JT, and Wang GX completed the endoscopic treatment; Zhao SQ was responsible for developing the methodology; Zhao SQ, Wang SY and Su L participated in the formal analysis and investigation; Zhao SQ wrote the original draft; Wang S, Su L and Zhao SQ participated in the review and editing; All the authors have read and approved the final manuscript. Both Sun SY and Wang S have played important and indispensable roles in the experimental design, data interpretation and manuscript preparation as the co-corresponding authors. This collaboration between Sun SY and Wang S is crucial for the publication of this manuscript and other manuscripts still in preparation.
Institutional review board statement: The study design follows the Declaration of Helsinki, and all relevant procedures have been approved by the Institutional Review Board and Ethics Committee of China Medical University. Clinical registration has been completed with the registration number 2024PS877K.
Informed consent statement: All study participants provided informed consent, and the study design was approved by the appropriate ethics review board.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: The data sharing will be conducted under the premise of ethical approval and privacy protection from corresponding author at wangs@sj-hospital.org.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sheng Wang, MD, Chief Physician, Professor, Department of Gastroenterology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang 110004, Liaoning Province, China. wangs@sj-hospital.org
Received: September 1, 2024 Revised: November 26, 2024 Accepted: January 14, 2025 Published online: March 27, 2025 Processing time: 175 Days and 11 Hours
Abstract
BACKGROUND
Endoscopic full-thickness resection (EFTR) is increasingly used for treating gastrointestinal stromal tumors (GISTs) in the stomach.
AIM
To compare the efficacy, tolerability, and clinical outcomes of EFTR vs surgical resection (SR) for gastric GISTs.
METHODS
We collected clinical data from patients diagnosed with GISTs who underwent either EFTR or SR at our hospital from October 2011 to July 2024. Patients were matched in a 1:1 ratio based on baseline characteristics and tumor clinical-pathological features using propensity score matching. We analyzed perioperative outcomes and follow-up data. The primary outcome measure was progression-free survival (PFS).
RESULTS
Out of 912 patients, 573 met the inclusion criteria. After matching, each group included 95 patients. The EFTR group demonstrated statistically significant advantages over the SR group in average operative time (P < 0.001), length of hospital stay (P < 0.001), time to resume liquid diet (P < 0.001), incidence of adverse events (P = 0.031), and hospitalization costs (P < 0.001). The en bloc resection rate was significantly different, with SR group at 100% and EFTR group at 93.7% (P = 0.038). The median follow-up was 2451.50 days. Recurrence occurred in 3 patients in the EFTR group and 4 patients in the SR group, with no statistically significant difference (P = 1.000). Factors associated with PFS included age, tumor size, high-risk category in the modified National Institutes of Health (NIH) risk score, and resection status. Resection status was identified as an independent prognostic factor for PFS (P = 0.0173, hazard ratios = 0.0179, 95%CI: 0.000655-0.491). Notably, there was no statistically significant difference in PFS between the two groups.
CONCLUSION
This study is a non-inferiority design. The EFTR group significantly outperformed the SR group in terms of operative time, length of hospital stay, time to resume a liquid diet, incidence of adverse events, and hospitalization costs, demonstrating its higher economic efficiency and better tolerability. Additionally, although the en bloc resection rate was lower in the EFTR group compared to the SR group, there were no significant differences in tumor recurrence rates and progression-free survival between the two groups. This study found no statistical difference in the primary endpoint of postoperative recurrence rates between the two groups. However, due to sample size limitations, this result requires further validation in larger-scale studies. The current results should be viewed as exploratory evidence.
Core Tip: This study evaluates endoscopic full-thickness resection (EFTR) vs surgical resection (SR) for gastric gastrointestinal stromal tumors. EFTR shows significant advantages in operative time, hospital stay, and adverse events compared to SR, with improved economic efficiency and tolerability. Although EFTR has a lower en bloc resection rate, both treatments yield similar tumor recurrence rates and progression-free survival. This research highlights EFTR's potential benefits in clinical practice while emphasizing that both methods offer comparable long-term outcomes.
