Bencini L, Adinolfi E. Minimally invasive approaches to small gastric stromal tumors: The less with the more. World J Gastrointest Surg 2025; 17(5): 101823 [DOI: 10.4240/wjgs.v17.i5.101823]
Corresponding Author of This Article
Lapo Bencini, MD, PhD, Senior Researcher, Department of Surgical Oncology, Careggi University and District Hospital, Careggi Main Florence University and Regional Hospital, 3 Brambilla Street, Florence 50134, Italy. lapbenc@tin.it
Research Domain of This Article
Surgery
Article-Type of This Article
Editorial
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. May 27, 2025; 17(5): 101823 Published online May 27, 2025. doi: 10.4240/wjgs.v17.i5.101823
Minimally invasive approaches to small gastric stromal tumors: The less with the more
Lapo Bencini, Elvira Adinolfi
Lapo Bencini, Elvira Adinolfi, Department of Surgical Oncology, Careggi University and District Hospital, Careggi Main Florence University and Regional Hospital, Florence 50134, Italy
Author contributions: Bencini L and Adinolfi E contributed to the references search, reading, and preparation of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: Lapo Bencini, MD, PhD, Senior Researcher, Department of Surgical Oncology, Careggi University and District Hospital, Careggi Main Florence University and Regional Hospital, 3 Brambilla Street, Florence 50134, Italy. lapbenc@tin.it
Received: September 27, 2024 Revised: February 20, 2025 Accepted: March 6, 2025 Published online: May 27, 2025 Processing time: 237 Days and 12.5 Hours
Abstract
In this paper, we comment on the article by Gu et al published in 2024, investigating whether there were differences in the clinical/perioperative outcomes of endoscopic and laparoscopic resections of gastric stromal tumors. Compared with most carcinomas, gastrointestinal stromal tumors are quite common worldwide and have a better prognosis. However, they respond to specific chemotherapies and do not routinely require standard lymphadenectomy. The gastric origin is known to be the most represented. Survival after proven radical surgery is excellent, with recurrences being extremely infrequent. Currently, induction/perioperative chemotherapy for high-risk tumors larger than 5 cm can downstage neoplasia and maintain good survival. Therefore, the standard of care for nonmetastatic, resectable tumors is surgical excision (avoiding formal lymphadenectomy) with or without chemotherapy. In the case of small- (2 cm) to medium- (5 cm) sized tumors, minimally invasive surgical approaches (laparoscopic or robotic) have been advocated, and more recently, a purely endoscopic technique has also been proposed. All these interventions are feasible and effective, although no definitive results have been published to prove the superiority of one over another; however, further investigation of its associated oncologic outcomes is still needed. Unfortunately, rigorous, prospective, randomized controlled trials are challenging to conduct, develop, and receive ethical approval for, whereas the final decision of the surgical route is often related to the availability of instrumentation and local expertise.
Core Tip: Survival after surgery for small, low-risk, gastric stromal tumors is excellent, with few perioperative complications and infrequent recurrences. Minimally invasive surgical approaches, such as laparoscopy, robotics, and endoscopy, should provide optimal clinical outcomes while maintaining oncologic adequacy. Although all of these methods have several strengths and limitations, instrument availability, clinical expertise, and need to preserve oncologic parameters play a crucial role in the choice of one over another.
