Goldilocks principle of minimally invasive surgery for gastric subepithelial tumors

doi:10.4240/wjgs.v15.i8.1629

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 15, Issue 8

This Article

Academic Content and Language Evaluation of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (2172)

All Articles published online

The chart showing PDF series, WORD series, HTML series, Figures (1-3) series, Tables (1-4) series.

Item

Count

PDF

WORD

HTML

1057

Figures (1-3)

196

Tables (1-4)

195

Sum=1530

Publishing Process of This Article

The chart showing Browse series, Download series.

Item

Count

Browse

142

Download

414

Sum=556

Aug 27, 2023 (publication date) through Jan 27, 2025

Times Cited of This Article

Times Cited (0)

Journal Information of This Article

Publication Name

World Journal of Gastrointestinal Surgery

ISSN

1948-9366

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Case Control Study

World J Gastrointest Surg. Aug 27, 2023; 15(8): 1629-1640
Published online Aug 27, 2023. doi: 10.4240/wjgs.v15.i8.1629

Table 1 Characteristics of patients undergoing endoscopic submucosal dissection and laparoscopic surgery

	ESD with/without backup surgery (n = 100)	Laparoscopic surgery (n = 94)	OR (95%CI)	P value
Age, yr, median (range)	56 (49-62)	62 (52-70)	1.04 (1.02-1.07)	0.001^a
Male gender, n (%)	46 (46)	47 (50)	1.17 (0.67-2.06)	0.577
Tumor size, n (%)
≤ 2 cm	72 (72)	15 (16)	1
3-5 cm	26 (26)	54 (57.4)	9.97 (4.82-20.62)	< 0.001^a
> 5 cm	2 (2)	25 (26.6)	60 (12.81-281)	< 0.001^a
Tumor location, n (%)
Upper	81 (81)	61 (64.9)	1
Middle	6 (6)	14 (14.9)	3.1 (1.13-8.53)	0.029^a
Low	13 (13)	19 (20.2)	1.94 (0.89-4.23)	0.096
Layer of tumor origin, n (%)
Submucosa	6 (6)	3 (3.2)	1
Muscularis propria	94 (94)	91 (96.8)	1.94 (0.47-7.97)	0.36
Exophytic growth, n (%)	11 (11)	53 (56.4)	10.46 (4.95-22.08)	< 0.001^a
Pathology, n (%)
Benign	55 (55)	14 (14.9)	1
Malignant or malignant potential	45 (45)	80 (85.1)	6.98 (3.5-13.94)	< 0.001^a
Procedure time, min, median (IQR)	75 (40-138)	130 (100-169)	-	< 0.001^a
Length of stay, d, median (IQR)	5 (4-7)	6 (4-6)	-	0.923
Clavien ≥ III complication, n (%)	5 (5)	3 (3.2)	-	0.527

^aP < 0.05.

ESD: Endoscopic submucosal dissection; OR: Odds ratio; CI: Confidence interval; IQR: Interquartile range.

Table 2 Characteristics of endoscopic submucosal dissection with backup surgery and laparoscopic surgery

	ESD with backup surgery (n = 27)	Laparoscopic surgery (n = 94)	OR (95%CI)	P value
Age, yr, median (range)	56 (50-64)	62 (52-70)	1.03 (1.00-1.06)	0.053
Male gender, n (%)	9 (33.3)	47 (50)	2.00 (0.82-4.90)	0.13
Tumor size, n (%)
≤ 2 cm	16 (59.3)	15 (16)	1
3-5 cm	11 (40.7)	54 (57.4)	7.66 (2.98-19.72)	< 0.001^a
> 5 cm	0 (0)	25 (26.6)	7.66 (2.98-19.72)	< 0.001^a
Tumor location, n (%)
Upper	23 (85.2)	61 (64.9)	1
Middle	1 (3.7)	14 (14.9)	3.11 (0.99-9.76)	0.052
Low	3 (11.1)	19 (3.2)	3.11 (0.99-9.76)	0.052
Layer of tumor origin, n (%)
Submucosa	0 (0)	3 (3.2)	-	1
Muscularis propria	27 (100)	91 (96.8)	-
Exophytic growth, n (%)	10 (37)	53 (56.4)	2.20 (0.91-5.3)	0.08
Pathology, n (%)
Benign	11 (40.7)	14 (14.9)	1
Malignant or malignant potential	16 (59.3)	80 (85.1)	3.93 (1.51-10.21)	0.005^a
Procedure time, min, median (IQR)	185 (150-245)	130 (100-169)	-	< 0.001^a
Length of stay, d, median (IQR)	7 (7-8)	6 (4-6)	-	< 0.001^a
Clavien ≥ III complication, n (%)	0 (0)	3 (3.2)	-	0.347

^aP < 0.05.

ESD: Endoscopic submucosal dissection; OR: Odds ratio; CI: Confidence interval; IQR: Interquartile range.

Table 3 Factors affecting procedure time and length of stay in endoscopic submucosal dissection with backup surgery and laparoscopic surgery

Factors	Without matched data			Propensity score matching
Factors	Adjusted mean difference	SE	P value	Adjusted mean difference	SE	P value
Procedure time
Surgery type
ESD with backup surgery	Reference			Reference
Laparoscopic surgery	-63.42	14.70	< 0.001^a	-56.40	18.60	0.005^a
Age	-0.43	0.42	0.304	-	-	-
Tumor size 2	22.04	13.35	0.101	-	-	-
Tumor location: middle or low	33.58	12.54	0.008^a	-	-	-
Exophytic growth	-4.54	10.98	0.680	-	-	-
Pathology with malignancy	-13.81	15.59	0.378	-	-	-
Length of stay
Surgery type
ESD with backup surgery
Laparoscopic surgery	-1.215	1.089	0.267	-2.00	0.516	0.001^a
Age	0.081	0.031^a	0.009^a	-	-	-
Tumor size 2	-0.348	0.988	0.726	-	-	-
Tumor location: middle or low	0.457	0.928	0.624	-	-	-
Exophytic growth	-0.218	0.813	0.789	-	-	-
Pathology with malignancy	-0.268	1.154	0.817	-	-	-

^aP < 0.05.

ESD: Endoscopic submucosal dissection.

Table 4 Malignant pathology and clinical outcomes after endoscopic submucosal dissection and laparoscopic surgery

	ESD with/without backup surgery (n = 100)	Laparoscopic surgery (n = 94)	P value
Malignant pathology in the group, n (%)	45 (45)	80 (85.1)	< 0.001^a
Malignant pathology
GIST, n (%)	43 (43)	78 (83.1)	< 0.001^a
High risk	0 (0)	11 (14.1)	0.001^a
Intermediate risk	5 (11.6)	20 (25.6)	0.002^a
Low risk	12 (27.9)	36 (46.2)	< 0.001^a
Very low risk	26 (60.5)	11 (14.1)	0.019^a
Neuroendocrine tumor, n (%)	1 (1)	1 (1)	1.000
Lipoleiomyosarcoma, n (%)	0	1 (1)	0.485
Recurrence, n (%)	0	6 (6.4)	0.012^a
Disease related mortality, n (%)	0	2 (2.1)	0.233

^aP < 0.05.

ESD: Endoscopic submucosal dissection; GIST: Gastrointestinal stromal tumors.

Citation: Chang WJ, Tsao LC, Yen HH, Yang CW, Chang HC, Kor CT, Wu SC, Lin KH. Goldilocks principle of minimally invasive surgery for gastric subepithelial tumors. World J Gastrointest Surg 2023; 15(8): 1629-1640
URL: https://www.wjgnet.com/1948-9366/full/v15/i8/1629.htm
DOI: https://dx.doi.org/10.4240/wjgs.v15.i8.1629