Journal of Clinical Gastroenterology and Hepatology Open Access

Comparison of safety and outcomes between endoscopic and surgical resections of small (≤5 cm) primary gastric gastrointestinal stromal tumors

6^th Annual European Conference on Gastroenterology

June 19-20, 2018 Paris, France

Taohong Pang, Yan Zhao, Qingqing Hu, Dekusaah Raymond, Weijie Zhang, Yi Wang, Bin Zhang, Shouli Cao1, Ying Lv Xiaoqi Zhang, Tingsheng Ling, Yuzheng Zhuge, Lei Wang, Xiaoping Zou, Qin Huang and Guifang Xu

Nanjing University Medical School, China Harvard Medical School, USA

Posters & Accepted Abstracts: J Clin Gastroenterol Hepatol

Abstract:

Background and aims: Endoscopic resection is increasingly performed for gastric gastrointestinal stromal tumors (GIST). However, the safety and long-term outcomes remain elusive. We aimed in this retrospective study to compare operative complications and prognosis between endoscopically resected GIST in size of ≤5 cm and the surgically resected one. Methods: In this single-center retrospective study, we compared demographics and clinical outcomes including operative complications postoperative courses, and the R0 resection rate between the endoscopy (n =268) and surgery (n =141) groups. Only GIST tumors in size of ≤ 5 cm were recruited for this comparison study. Results: Overall, the mean age of patients was 59.0 years (range: 31.0-83.0). The male-female ratio was 0.68. The most common site of GIST was, in a descending order, the gastric fundus (55%), corpus (27.6%), cardia (10.8%), antrum (6.6%). Compared with the surgery group, GIST tumors in the endoscopy group was significantly smaller (1.69±0.9 cm, compared to 3.20±1.2 cm in the surgery group; P<0.001) in size, shorter postoperative hospital stay (4.66±1.5 days, compared to 8.11±5.0; P<0.001), shorter time to first fluids diet (1.94±1.1 days, compared to 4.63±2.6; P<0.001), fewer incidence of operative and post-operative complications (p<0.05), and lower hospital costs (20115.4±5113.5¥ compared to 43378.4±16795.7¥; P<0.001).The R0 resection rate was significantly lower in the endoscopy (93.3%) than in the surgery (99.3%) groups (P<0.01). In the endoscopy group, 176 (65.7%), 69 (25.7%), 14 (5.2%) and 9(3.4%) patients were found to be very low, low, intermediate, and high risk, respectively. In contrast, 27 (19.1%), 87 (61.7%), 14 (10.0%), 13 (9.2%) patients were found to be very low, low, intermediate, and high risk in the surgery group, respectively. The risk stratification was significantly different between the endoscopy and surgery groups (P<0.001). Among 409 cases, 50 (12.2%) patients were found to be intermediate or high risk. Among 50 patients, only 20 patients received adjuvant therapy with imatinib after resection. Seven of the 20 patients took imatinib 1 to 3 months because of its side effects and high costs. However, during 33.5 months of follow-up, no local or distant tumor recurrence was observed, and two patients were died owe to other disease in surgery group. Conclusions: Endoscopic resection of selected gastric GISTs (≤5cm) is feasible and safe and is associated with a better intraoperative outcome and an equal postoperative course compared with surgery group.