The Analysis Of The Effectiveness Of Endoscopic Resection For Large Gastrointestinal Stromal Tumors Of Stomach

Objective and background:Gastrointestinal stromal tumors(GISTs)are the most common mesenchymal tumors of the digestive tract with potential for malignant transformation.Gastrointestinal stromal tumors of stomach,most common of GISTs,are mainly treated by open surgery or laparoscopic resection in the past.In recent years,with the development of endoscopic technology and equipment,endoscopic resection also plays an important role in the treatment of gastric stromal tumors.Evaluate the safety and feasibility of endoscopic treatment for gastric stromal tumors by comparing the clinical efficacy of endoscopic resection with laparoscopic resection for large gastric stromal tumors(the maximum diameter between 3.0-5.0cm).Methods:A retrospective analysis was made based on the clinical data of endoscopic(29 cases)and laparoscopic(26 cases)resection for gastric stromal tumors,including the operation time,intraoperative blood loss,intact tumor removal rate,operative complications,postoperative fasting time,recovery time of gastrointestinal function,postoperative hospital stay,total cost of hospitalization,tumor risk grade,recurrence rate.Results : Compared with the laparoscopic group,the endoscopic group required shorter operation time[45(35-60)min vs 70(60-85)min,P<0.05],less intraoperative blood loss[15(10-15)ml vs 20(10-20)ml,P<0.05],earlier recovery time of gastrointestinal function[12(6-24)h vs 20(18-24)h,P<0.05],but the intact tumor removal rate is lower(89.7%).In terms of complications,13 patients(44.8%)suffered perforation after endoscopic full-thickness resection in endoscopic group,1 patient(3.4%)lost50mlbloodduringoperation,delayed hemorrhage occurred in 1 patient(3.4%)thirty hours after operation and peritonitis in 1 patient who had a fever,abdominal pain,peritoneal irritation sign.In the laparoscopic group,1 patient(3.8%)lost 100 mlbloodduringthe gastric wedge resection,and there was 1 patient(3.8%)complicated with peritonitis,and 1patient(3.8%)complicated with anastomotic leakage.The other baseline statistics and otherperioperative data showed no statistical difference.The postoperative follow-up time were30(17.5-50)and 38.5(26-49.8)months in the endoscopic and laparoscopic group.During the follow-up,1 patient suffered tumor recurrence in the endoscopic group,1patient suffered tumor recurrence and 1patient suffered abdominal metastatic in the laparoscopic group.Conclusion:Endoscopic resection might be an alternative therapeutic modality for large gastric stromal tumors,and requires shorter operation time,less intraoperative blood loss,earlier recovery time of gastrointestinal function.