Comparison of the treatment outcomes of endoscopic and surgical resection of gastrointestinal stromal tumors in the stomach: a propensity score-matched case-control study.

Abstract

BACKGROUND AND AIMS\nWe aimed to investigate the safety and efficacy of endoscopic resection (ER) compared with surgical resection (SR) of gastric gastrointestinal stromal tumors (GISTs).\n\n\nMETHODS\nThis study included 51 and 403 patients who underwent ER and SR, respectively, for ≤5 cm GISTs in the stomach between June 2005 and August 2017. After propensity score matching (1:1) using age, sex, tumor size, mitotic count, and comorbidities, the oncological outcomes were compared with 48 patients each from ER and SR groups.\n\n\nRESULTS\nThe ER group had significantly shorter hospital stay (4.4±2.9 vs 6.6±3.6 days, P<0.001) and procedure time (38.3±24.2 vs 66±33.3 min, P<0.001). The R0 resection rate was 62.7% in the ER group and 98.5% in the SR group. In the ER group, macroperforation occurred in 6 patients (11.8%) with a tumor located in the fundus (4/6, 66.7%) or body (2/6, 33.3%). All cases of perforation were cured with conservative treatment. In the SR group, postoperative adverse events such as stricture and leakage occurred in 7 patients (1.7%) with a tumor located in the antrum (4/7, 57.1%) or cardia (3/7, 42.9%) in SR group. After matching, the overall mean follow-up period was 47.9±37.8 months in the ER group and 41.3±22.6 months in the SR group. No recurrence or distant metastasis occurred in either group during the follow-up period.\n\n\nCONCLUSIONS\nER is an effective and safe therapeutic method that might be comparable to SR for treating small-sized (≤5 cm) gastric GISTs. Selecting the resection method according to the tumor location seems appropriate.