Comparing The Efficacy Of Different Surgical Methods And Application Of 3D Printing Technology In Digestive Tract Submucosal Tumors

Objective:1)To investigate the related risk factors affecting postoperative recurrence and recurrent metastasis in patients with gastrointestinal neuroendocrine tumors(GI-NETs),and compare the therapeutic efficacy of different surgical methods as well as their impacts on prognosis;2)To explore the guiding role of 3D printing technology in endoscopic diagnosis and treatment of the upper digestive tract submucosal tumors(SMTs).Method:1)The clinical data of 153 GI-NETs patients treated in our hospital from January 2010 to December 2019 were collected and retrospectively analyzed.The tumor outcome(outcome is defined as recurrence and metastasis)was obtained through the patient’s postoperative return to the hospital for follow-up review;2)We analyzed their clinical data and calculated the rates of recurrence and metastasis within 5 years,carried out prognostic factor analysis and survival analysis,compared the efficacy of different surgical methods at the same time.Univariate analysis of prognosis was performed by Log-rank test,and risk factors with P<0.1 were included in multivariate Cox regression model to obtain independent risk factors affecting prognosis.The recurrence rate of different groups was compared by X~2test;3)We collected and statistically analyzed the age,gender,treatment method,tumor diameter,tumor source level,postoperative complications and other information of 172 patients with upper digestive tract SMTs who received endoscopic treatment in our hospital from September 2018 to December 2020.We performed reconstruction and 3D printing on 15 patients’SMTs with large diameter,complex structure.The 3D-printed model was compared with traditional imaging examination to evaluate the guiding role of 3D printing technology in the preoperative endoscopic diagnosis and treatment of patients with the upper digestive tract SMTs.Result:1)A total of 153 patients diagnosed with GI-NETs pathologically,90 were males(58.82%)and 63 were females(41.18%).There were 114 patients(74.51%)in G1phases,25(16.34%)in G2 phases and 14(9.15%)in G3 phases.112 patients(73.20%)did endoscopic surgery and 41 patients(26.80%)did surgery.There were 26 patients(16.99%)with recurrence and metastasis within 5 years.The rates of recurrence and metastasis of locations in duodenum,esophagus,stomach and rectum within 5 years were 1.31%,3.92%,3.27%and 8.50%,respectively.The rates of recurrence and metastasis of endoscopic surgery and surgery within 5 years were 3.92%and 13.07%,respectively.Log-rank test results showed that different ages,different tumor sites,different pathological grades,and different surgical methods had statistical difference in the recurrence and metastasis of GI-NETs.Cox proportional hazard regression model analysis showed that tumor size,pathological grade,and tumor tissue found at the surgical margin were independent risk factors affecting prognosis(P<0.05),and the larger the tumor size and pathological grade were,the higher the risk of postoperative recurrence and metastasis was.There was no statistical difference in different treatments of the recurrence and metastasis of GI-NETs with a size of less than 2cm in G1 and G2 phases(P>0.05);2)Among the 172 patients with upper digestive tract SMTs,42(24.42%)were stromal tumors,105(61.05%)were leiomyoma,7(4.07%)were neuroendocrine tumors,8(4.65%)were lipoma,and 10(5.81%)were ectopias.The age of the patient was 50.44±10.01 years old,the youngest was 17 years old and the oldest was 76 years old.The tumor diameter was 1.48±1.05cm,the minimum diameter was 0.3cm,and the maximum diameter was 6.5cm.89 were male(51.74%)and 83 were female(48.26%).113(65.70%)were younger than 55 years old.59(34.30%)were older than 55 years old.76 of esophagus(44.19%),90 of stomach(52.33%),6 of duodenum(3.49%);There were 55 cases(31.98%)with tumor diameter smaller than 1cm,89 cases(51.74%)with tumor diameter between 1cm and 2cm,and 28 cases(16.28%)with tumor diameter larger than 2cm.Among the patients with complications,perforation occurred in 4 patients(2.33%),intraoperative massive bleeding or delayed postoperative bleeding in 3 patients(1.74%),and pneumoperitoneum occurred in 1 patient(0.58%).Among the patients with complications,perforation occurred in 4 patients(2.33%),intraoperative massive bleeding or delayed postoperative bleeding in 3 patients(1.74%),and pneumoperitoneum occurred in 1 patient(0.58%).3)The 3D-printed models of 15 cases clearly showed the anatomical structure of the tumors,adjacent important organs and large vessels in the thoracic cavity,etc.At the same time,the anatomical relationship of the tumors could be intuitively understood from multiple angles and directions.The model could clearly show the tumor shape,size,anatomical position and adjacent relationship with surrounding tissues,organs and blood vessels.Conclusion:1)Tumor size,pathological grade and tumor tissue found at the surgical margin were independent risk factors for postoperative recurrence and metastasis.GI-NETs in G1 and G2 phases,while smaller than 2cm can be resected under endoscopy.2)The3D-printed model could intuitively understand the anatomical relationship of the tumor from multiple angles and directions,and its clarity was much higher than 2D images such as CT and EUS.The 3D-printed model could help doctors fully understand the patient’s condition before surgery,have a clearer understanding of the size,location,shape,adjacent factors of the tumor,avoid the relative blindness of traditional surgery in the past,and provide patients with a more safe and reliable treatment plan.