Retrospective Cohort Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2019; 7(7): 830-838
Published online Apr 6, 2019. doi: 10.12998/wjcc.v7.i7.830
Clinical evaluation of endoscopic resection for treatment of large gastric stromal tumors
Yuan-Yuan Xiang, Yuan-Yuan Li, Ling Ye, Yin Zhu, Xiao-Jiang Zhou, You-Xiang Chen, Guo-Hua Li
Yuan-Yuan Xiang, Yuan-Yuan Li, Ling Ye, Yin Zhu, Xiao-Jiang Zhou, You-Xiang Chen, Guo-Hua Li, Department of Digestive Diseases, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Author contributions: All authors helped to perform the research; Xiang YY wrote the manuscript, performed the procedures, and analysed the data; Li YY wrote the manuscript, drafted the concept and design, performed the experiments, and analysed the data; Ye L contributed to writing the manuscript and drafting the concept and design; Zhu Y, Zhou XJ, and Chen YX contributed to writing the manuscript; Li GH contributed to writing the manuscript and drafting the concept and design.
Institutional review board statement: An ethical review of this study was waived by the Ethics Committee of the First Affiliated Hospital of Nanchang University.
Informed consent statement: At the time of surgery, the patient had signed the informed consent form, and after the patient was discharged, each patient verbally agreed to the study by telephone.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: 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/
Corresponding author: Guo-Hua Li, PhD, Doctor, Professor, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng Street, Donghu District, Nanchang 330006, Jiangxi Province, China. 516360169@qq.com
Telephone: +86-791-83969145
Received: December 22, 2018
Peer-review started: December 25, 2018
First decision: January 30, 2019
Revised: March 8, 2019
Accepted: March 16, 2019
Article in press: March 16, 2019
Published online: April 6, 2019
Processing time: 104 Days and 23.5 Hours
Abstract
BACKGROUND

Gastric stromal tumor is a digestive tract mesenchymal tumor with malignant potential, and endoscopic techniques have been widely used in the treatment of gastric stromal tumors, but there is still controversy over their use for large gastric stromal tumors (≥ 3 cm).

AIM

To evaluate the clinical long-term efficacy and safety of endoscopic resection for large (≥ 3 cm) gastric stromal tumors.

METHODS

All patients who underwent endoscopic resection or surgery at our hospital from 2012 to 2017 for pathologically confirmed gastric stromal tumor with a maximum diameter of ≥ 3 cm were collected. The clinical data, histopathologic characteristics of the tumors, and long-term outcomes were recorded.

RESULTS

A total of 261 patients were included, including 37 patients in the endoscopy group and 224 patients in the surgical group. In the endoscopy group, the maximum tumor diameter was 3-8 cm; the male: Female ratio was 21/16; 34 cases had low-risk tumors, 3 had intermediate-risk, and 0 had high-risk; the mean follow-up time was 30.29 ± 19.67 mo, no patient was lost to follow-up, and no patient received chemotherapy after operation; two patients with recurrence had low-risk stromal tumors, and neither had complete resection under endoscopy. In the surgical group, the maximum tumor diameter was 3-22 cm; the male: Female ratio was 121/103; 103 cases had low-risk tumors, 75 had intermediate-risk, and 46 had high-risk; the average follow-up time was 38.83 ± 21.50 mo, 53 patients were lost to follow-up, and 8 patients had recurrence after operation (6 cases had high-risk tumors, 1 had intermediate-risk, and 1 had low-risk). The average tumor volume of the endoscopy group was 26.67 ± 26.22 cm3 (3.75-120), all of which were less than 125 cm3. The average volume of the surgical group was 273.03 ± 609.74 cm3 (7-4114). Among all patients with a tumor volume < 125 cm3, 7 with high-risk stromal tumors in the surgical group (37.625 cm3 to 115.2 cm3) accounted for 3.8% (7/183); of those with a tumor volume < 125 cm3, high-risk patients accounted for 50% (39/78). We found that 57.1% (12/22) of patients with high-risk stromal tumors also had endoscopic surface ulcer bleeding and tumor liquefaction on ultrasound or abdominal computed tomography; the ratio of tumors positive for both in high-risk stromal tumors with a volume < 125 cm3 was 60% (3/5).

CONCLUSION

Endoscopic treatment is safe for 95.5% of patients with gastric stromal tumors with a tumor diameter ≥ 3 cm and a volume of < 125 cm3 without endoscopic surface ulcer bleeding or CT liquefaction.

Keywords: Endoscopic resection; Surgery; Gastric stromal tumor; Clinical evaluation

Core tip: This study mainly analysed the clinical data of endoscopic resection or surgical treatment of large (≥ 3 cm) gastric stromal tumors from January 2012 to December 2017 at our hospital. The endoscopy group had no high-risk stromal tumors, while patients with the same size tumors were considered high risk in the surgical group. The maximum tumor diameter was significantly larger in the surgical group than in the endoscopy group. A total of 22 patients had tumors with a volumes < 125 cm3 without liquefaction or surface ulcer bleeding, including 1 high-risk patient.