| AimTo evaluate the clinical long-term efficacy and safety of endoscopic resection for large(≥3 cm)gastric stromal tumors.MethodsAll patients who underwent endoscopic resection or surgery in our hospital from2012 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.Results261 patients were included,including 37 patients in the endoscopy group,with a maximum tumor diameter of 3-8 cm.The male:female ratio was 21/16,34 cases were low risk,3 cases were intermediate risk,and 0 case were high risk.The mean follow-up time was 30.29±19.67 months,no patient was lost to follow-up,and no patient received chemotherapy after operation.Two patients with recurrence were low-risk stromal tumors,and neither had complete resection under endoscopy.224patients were in the surgical group with a maximum tumor diameter of 3-22 cm,the male:female ratio was 121/103,103 cases were low risk,75 cases were intermediate risk,and 46 cases were high risk.The average follow-up time was 38.83±21.50months,53 patients were lost to follow-up,and 8 patients had recurrence after operation(6 cases were high risk,1 case was intermediate risk,and 1 case was low risk).Therefore,we can find that all patients in the endoscopic group were patients with low or moderate risk,and only 2 patients in the long-term follow-up had recurrence due to incomplete resection of the tumor.Therefore,we can consider that patients in the endoscopic group with complete resection of low or moderate risk gastric stromal tumor are safe.However,how to determine the pathological grade of gastric stromal tumor before surgery?Because the maximum diameter of the tumor in the surgical group is significantly larger than that in the endoscopy group,the high-risk patients are also significantly more than the endoscopy group,but the endoscopy group has no high-risk stromal tumors,while the same size tumors have high-risk patients in the surgical group.We guess this may be related to the volume of the tumor.According to the volume analysis of the tumor,we find the average tumor volume of the endoscopy group was 26.67±26.22 cm~3(3.75-120),all of which were less than 125 cm~3.The average volume of the surgical group was273.03±609.74 cm~3(7-4114),78 cases of tumor volume≥125 cm~3,while the intermediate risk and high risk stromal tumors accounted for 50%each.and<125 cm~3patients also have 7 cases of high-risk stromal tumors(minimum volume:37.625 cm~3,maximum volume:115.2 cm~3).Among all patients with tumor volume<125 cm~3,7patients with high-risk stromal tumors in the surgical group(37.625 cm~3 to 115.2 cm~3)accounted for 3.8%(7/183);of those with tumor volume≥125 cm~3,high-risk patients accounted for 50%(39/78).For the preoperative endoscopy of different pathological grades of gastric stromal tumors,whether the tumor surface ulcer bleeding and ultrasound or abdominal CT see tumor liquefaction were analyzed.we found that the ratio of both positive rates was 57.1%(12/22)in the high-risk group,the ratio of both positive for high-risk stromal tumor with tumor volume<125 cm~3 was 60%(3/5),among patients with tumor volume<125 cm~3 and both of them were negative,1.7%(1/60)were at high risk and 98.3%(59/60)were at medium and low risk.ConclusionsEndoscopic treatment is safe for 98.3%of patients with gastric stromal tumors with a tumor diameter of≥3 cm and a volume of<125 cm~3without tumor liquefaction and ultrasound. |
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