Published online Apr 6, 2019. doi: 10.12998/wjcc.v7.i7.830
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
Gastrointestinal stromal tumors (GISTs), first proposed by Mazur et al in 1983, are a group of gastrointestinal stromal tumors with malignant differentiation potential, which are not sensitive to radiotherapy and chemotherapy. The pathological examination technique is difficult to popularize widely, so it is recommended to follow the diameter < 2 cm at present, while the diameter > 2 cm is treated surgically, but the malignant change and metastasis may occur during the long-term follow-up period. Therefore, surgical resection is the only way to treat GISTs, mainly including traditional open surgery, laparoscopic surgery, and endoscopic digestive surgery. Past transmission Open laparotomy is the first choice for the treatment of gastrointestinal stromal tumors, but for the patients with smaller diameter of the tumor, the surgical trauma is greater. In addition, the perioperative mortality of elderly patients can be as high as 1% or more. At the same time, the traditional open operation time is long, intraoperative bleeding is much, and the operation cost is expensive. Laparoscopic surgery has been proved to be a safe and effective method for the treatment of gastric stromal tumors with a diameter ≤ 5 cm, and it is also effective in the treatment of gastric stromal tumors with a tumor diameter > 5 cm. However, there are some limitations to the microstromal tumors whose diameter is smaller than 1 cm and the gastric stromal tumors with special location. If it is difficult to remove the large tumor through the orifice, it is necessary to cut open the abdominal wall or prolong the surgical incision. Moreover, it is difficult to expose and operate the tumors near the gastric cardia and the great curvature of the stomach body near the fundus of the stomach. In recent years, with the continuous development of endoscopic technology and endoscopic instruments, endoscopic resection of gastric GISTs is possible. Many studies have shown that endoscopic resection is safe and effective in treating gastric GISTs. It provides an effective minimally invasive method for the treatment of gastric stromal tumors. However, endoscopic resection is prone to major complications, such as bleeding, perforation, and positive margin. There are still doubts about the safety and efficacy of endoscopic treatment for gastric stromal tumors. In recent years, there have been many reports about the clinical evaluation of endoscopic treatment of gastric stromal tumors, which confirmed the efficacy and safety of endoscopic treatment of < 3 cm gastric stromal tumors. However, there are few reports about endoscopic treatment of large gastric stromal tumors (≥ 3 cm). The efficacy and safety of endoscopic treatment for < 5 cm gastric stromal tumors were confirmed, but the follow-up time was short and the sample size was small. More literature reports are needed to further confirm the long-term efficacy of endoscopic treatment for large stromal tumors of the stomach.
The purpose of this study was to collect the clinical and pathological data of all patients diagnosed with gastric stromal tumors with the largest diameter ≥ 3 cm at our hospital during the last six years from 2012 to 2017, who were treated by endoscopy or surgery. The long-term curative effect was evaluated by follow-up to evaluate the long-term efficacy of endoscopic treatment of large gastric stromal tumors, and to provide a direction for the choice of surgical methods for large gastric stromal tumors in the future.
The main purpose of this study was to observe the long-term efficacy of endoscopic treatment of gastric macrostromal tumors, and to reduce the pain associated with surgical treatment in patients with large gastric stromal tumors. More patients with large stromal tumors of the stomach can enjoy the benefits of minimally invasive surgery and improve the quality of life.
From 2012 to 2017, the clinical data of all patients with large stromal tumor of the stomach treated by endoscopy or surgery were analyzed and a long-term follow-up was carried out. In this study, the chi-square test was used to test the statistical differences between groups, which clearly confirmed the differences between the two groups.
In this study, we found that endoscopic therapy can be used to treat large gastric stromal tumors, but it needs to meet certain conditions, and should be evaluated according to the results of preoperative ultrasound. There is controversy about whether endoscopic treatment of large gastric stromal tumors can be performed in previous studies. This study provides a good answer to the circumstances in which patients with large stromal tumors of the stomach can be treated by endoscopy. It provides a direction for the treatment of large stromal tumors of the stomach in the future.
In this study, we found that the volume of gastric stromal tumor treated by endoscopy is smaller than that by surgical treatment. For patients with moderate-risk stromal tumors, oral chemotherapeutic drugs may not be needed, and endoscopy can be used to treat large gastric stromal tumors. However, certain conditions need to be met. Endoscopic treatment is safe for 95.5% of patients with gastric stromal tumors with a diameter ≥ 3 cm and a volume < 125 cm3 without endoscopic surface ulcer bleeding or CT liquefaction. This study will provide a direction for the choice of treatment methods for patients with large stromal tumors of the stomach in clinical work.
There are many other aspects to judge the pathological grade of gastric stromal tumors before operation. We can continue to study more factors affecting the pathological grade of gastric stromal tumors on the basis of this study in the future. This study is a retrospective single-center study. There were no high-risk stromal tumors in the endoscopy group and no patients with a maximum tumor diameter ≥ 10 cm or volume ≥ 125 cm3. In the future, a multicenter prospective study of larger stromal tumors of the stomach could be attempted, to further explore the long-term safety and efficacy of endoscopic treatment for large stromal tumors of the stomach.