Copyright
©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Goldilocks principle of minimally invasive surgery for gastric subepithelial tumors
Wei-Jung Chang, Lien-Cheng Tsao, Hsu-Heng Yen, Chia-Wei Yang, Hung-Chi Chang, Chew-Teng Kor, Szu-Chia Wu, Kuo-Hua Lin
Wei-Jung Chang, Lien-Cheng Tsao, Hung-Chi Chang, Kuo-Hua Lin, Department of General Surgery, Changhua Christian Hospital, Changhua 50006, Taiwan
Hsu-Heng Yen, Chia-Wei Yang, Department of Gastroenterology, Changhua Christian Hospital, Changhua 50006, Taiwan
Hsu-Heng Yen, General Education Center, Chienkuo Technology University, Changhua 50006, Taiwan
Hsu-Heng Yen, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
Chew-Teng Kor, Big Data Center, Changhua Christian Hospital, Changhua 50006, Taiwan
Chew-Teng Kor, Graduate Institute of Statistics and Information Science, National Changhua University of Education, Changhua 50007, Taiwan
Szu-Chia Wu, Transplant Medicine & Surgery Research Center, Changhua Christian Hospital, Changhua 50006, Taiwan
Author contributions: Yen HH, Chang HC, and Lin KH designed research; Tsao LC, Yen HH, Yang CW, Chang HC, and Lin KH performed research; Tsao LC, Yen HH, and Kor CT contributed new reagents/analytic tools; Kor CT and Wu SC analyzed the data; Chang WJ and Lin KH wrote the paper.
Institutional review board statement: The study was approved by the Institutional Review Board of Changhua Christian Hospital (approval No. 220117).
Informed consent statement: This retrospective study had a waiver of informed consent due to retrospective nature.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
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.
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: Kuo-Hua Lin, MD, Surgeon, Department of General Surgery, Changhua Christian Hospital, No. 135 Nanxiao Street, Changhua 50006, City, Changhua County, Taiwan. khlin120380@gmail.com
Received: April 26, 2023
Peer-review started: April 26, 2023
First decision: May 25, 2023
Revised: June 6, 2023
Accepted: July 4, 2023
Article in press: July 4, 2023
Published online: August 27, 2023
Processing time: 121 Days and 3.3 Hours
ARTICLE HIGHLIGHTS
Research background
With recent advancements in endoscopic and laparoscopic management of gastric subepithelial tumors (SETs), different approaches to minimally invasive surgery have been adopted to improve the clinical outcomes.
Research motivation
To treat gastric SETs, the effectiveness and safety of endoscopic resection (ER), laparoscopic resection (LR), or our hybrid method were compared in terms of procedure duration, duration of hospital stay, and major complications.
Research objectives
This retrospective study compared the differences between ER and LR, and between ER with backup surgery and LR, in terms of demographic data, tumor characteristics, and perioperative outcomes. Thus, Goldilocks principle was used to determine the best type of minimally invasive surgery for gastric SETs.
Research methods
This retrospective review of records was performed on all patients of gastric SETs with high probability of surgical intervention undergoing tumor resection in the operating theater between January 2013 and December 2021. All patients were divided into two groups, either group of ER or group of LR.
Research results
Totally, 194 patients were divided into the ER group (n = 100) and LR group (n = 94). In the ER group, 27 patients required backup laparoscopic surgery after an incomplete ER. The patients in the ER group had small tumor sizes and shorter procedure durations while the patient in the LR group had large tumor sizes, exophytic growth, malignancy, and tumors that were more often located in the middle or lower third of the stomach. Both groups had similar durations of hospital stays and a similar rate of major postoperative complications. For the patients in the ER group who underwent backup surgery required longer procedures (56.4 min) and prolonged stays (2 d) compared to the patients in the LR group without the increased rate of major postoperative complications. The optimal cut-off point for the tumor size for laparoscopic surgery was 2.15 cm.
Research conclusions
ER was indicated for a smaller tumor and intraluminal growth, whereas LR was indicated for a larger tumor (optimal cut-off point: 2.15 cm), tumors located in the middle or lower third of the stomach, exophytic growth, and more aggressive malignancy behavior. Backup surgery is preserved for incomplete ER to effectively reduce associated morbidities.
Research perspectives
Multidisciplinary teamwork adopts different strategies to yield the efficient clinical outcome according to the tumor characteristics.
