Comparison Of Clinical Effect Between Endoscopic And Surgical Resection On Gastric Stromal Tumors

[Introduction]Gastric stromal tumors(GSTs)is rare disease in gastric system.Traditional therapy for GST is mainly surgery.In recent years,with the increasing volume of reports of treatments of GSTs,the advantages of endoscopic treatment are obvious,which involves minimally invasion and whole resection of the lesion.Furthermore,endoscopic process can provide a reliable basis for further pathological diagnosis.But there were few reports of comparisons between endoscopic resections and surgical treatments for those lesions.This research provides overview of a retrospective study,including 34 cases of endoscopic treatments and 24 cases of surgical treatments on low risk GSTs.The data were collected from the 174th Hospital of the PLA,from June 2010 to December 2016.The effectiveness,safety,cost and follow-up results were compared between the two therapic methods,in order to provide a reference of value for the optimal treatment for patients with low risk GST.[Methods]In this retrospective study,we collected the comprehensive clinical data of patients under endoscopic resection,from June 2010 to December 2016,in the 174th Hospital of the PLA.At the same time,we filtered out the pathologic data of the patients who had received the surgical excision during the same period.Combining the pathologic data with the hospitalization records,we selected the cases without metastasis in other parts of the organs in this control study.These cases are divided into the endoscopic therapy group and the surgery therapy group.Following are the main comparisons between the two groups:the complete resection rate,recurrence rate,metastasis rate,complications during hospitalization(gastrointestinal bleeding,perforation,abdominal infections and delayed gastric emptying)and postoperative complications,as well as the follow-up long-term quality of life(weight loss and dyspepsia).[Results]Compared with surgery,endoscopic resection has the similar efficacy rates in low risk GSTs,including complete resection rate(30/34 v.s 23/24,P=0.392).There were no recurrence and metastasis cases in the study.The amount of bleeding in surgeries is 198.26±95.32 ml.One patient had the blood transfusion during operation,namely the blood transfusion rate is 4.17%.There was no obvious bleeding in the endoscopic treatment.During hospitalization,the incidence of complications between endoscopic treatment and surgical treatment are not significantly different:postoperative bleeding(7/34 v.s 3/24,P = 0.467),perforation(3/34 v.s 0/24,P=0.414),abdominal infections between the two groups(0/34 v.s 1/24,P=0.397).There was no delayed gastric emptying patient between the two groups.The days complications occur after surgery(3.98 ± 1.05 v.s 6.71 ± 3.15,P=0.294)show no significantly different.We successfully followed up 30 cases of endoscopic and 17 surgical patients.There are no significant differences in postoperative complications:weight loss(10/30 v.s 7/17,P=0.486),symptoms of indigestion(8/30 v.s 8/17,P=0.238).Endoscopic group has the shorter mean hospital stay than surgery group(7.18 ±2.83 vs.12.04±4.39,P=0.018).The hospitalization costs of internal medicine group(RMB)is less than that of surgery(6183.4±1162 v.s 17624.6±2307,P=0.013).The average daily cost of hospitalization was not statistically significant(892.48±119.38 v.s 1352.67 ± 175.08,P=0.759).[Conclusion]For low risk gastric stromal tumors,endoscopic resection and surgical treatment have relatively similar efficacy.However,the surgery operations brings higher level of trauma and injuries.In our study,endoscopic resection has the curative resection rate up to 88.2%(30/34).Though the follow-up recurrence rates between surgery and endoscopic are similar,endoscopic treatment has more advantages,e.g.less trauma,shorter hospital stay and less cost.This result demonstrates endoscopic treatment is a promosing therapeutic modality given its minimally invasion.For low risk gastric stromal tumors,endoscopic treatment has proven to be a safer,more efficient and cost-effective therapeutic option.In addition,complete resection of lesions under endoscopy may provide adequate pathological basis to guide further treatment.