Effectiveness And Safty Of Endoscopic Versus Laparoscopic Resection For Gastric Stromal Tumors:A Meta-analysis

Objective:To evaluate the literatures comparing endoscopic versus laparoscopic surgical resection of gastric GISTs to assess the effectiveness and safety of this minimally invasive technique.Methods:Databases including Pub Med,MEDLINE,Web of Science,CNKI database,Wan-Fang database were searched.Studies comparing the endoscopic and laparoscopic approaches to the resection of gastric GISTs were included in this systematic review.Two reviewers independently performed the screen of titles and abstracts,the full manuscript review,the data extraction and the risk of bias assessment.A quantitative analysis was performed using Review Manager 5.3 software.Result:Of the 161 studies identified,eight studies were finally included.Our meta-analysis included 627 patients with gastric GISTs;325patients had undergone endoscopic surgery and 302 patients had undergone laparoscopic surgery.Through the data analysis we knew that the endoscopic approach was associated with a significantly less estimatedblood loss(MD-15.90,95%CI:-22.13~9.66,P<0.05)?less operation time(MD=-27.59,95% CI:-43.95~11.23,P<0.05)?lower length of hospital stay(MD=-2.53,95%CI:-3.74 ~-1.31,P<0.05)?shorter intestinal recovery time(MD=-11.25,95%CI:-17.16 ~-5.34,P<0.05)?lower hospitalization expenses(MD=-1.84,95%CI:-3.21~-0.47,P<0.05).There was no observed difference in success ratio of operation(OR=3.44,95%CI:0.38~ 31.8,P>0.05)?rate of operation complications(OR=3.44,95%CI:0.38~31.8,P>0.05)?recurrence rate(OR=1.63,95%CI:0.45 ~ 5.83,P>0.05)compared with the laparoscopic approaches.Conclusion:This study supports that endoscopic surgery for small gastric GISTs is safe and effective.Further large-scale randomized controlled trials are still needed to rigorously assess oncologic outcomes.