The Safety And Efficacy Of Endoscopic Versus Laparoscopic Treatment For Gastric Stromal Tumors:A Meta-analysis

Objective:The safety and efficacy of endoscopic procedure and laparoscopic procedure of gastric stromal tumors were compared by meta-analysis methods.Methods:The main Chinese and English literature databases were searched to obtain relevant literatures comparing endoscopic resection and laparoscopic resection of gastric stromal tumors.The literature was screened according to the established criteria,and evaluated and meta-analyzed the included documents.Results:A total of 12 studies were included.The results show that:1.When the diameter of gastric stromal tumor is less than 2cm,the surgical time(MD=-58.94,95CI%=-102.72,-10.16,P=0.008),fluid recovery time(SMD=-0.57,95CI%=-1.06,-0.09,P=0.02);and postoperative hospitalization time(MD=-1.54,95%CI=-2.47,-0.61,P=0.001)of endoscopic resection are shorter than those of laparoscopic resection,and intraoperative blood loss is less than that of laparoscopic resection(MD=-16.72,95CI%=-32.17,-1.28,P=0.03).There were no significant differences in the complete resection rate(Log OR=-0.69,95%CI=-3.91,2.53,P=0.68),complication rate(Log Peto's ORF=0.39,95%CI=-0.33,1.12,P=0.29)and recurrence rate(Log Peto's OR=0.30,95%CI=-2.02,2.63,P=0.80).2.When the gastric stromal tumor is 2-5cm in diameter,the surgical time(MD=-27.15,95CI%=-48.38,-5.92,P=0.01),intraoperative blood loss(MD=-24.19,95CI%=-36.02,-12.36,P<0.001),first exhaust time(SMD=-1.15,95%CI=-1.89,-0.40,P<0.001),and postoperative laxative time(SMD=-0.41,95%CI=-0.78,-0.03,P=0.03)are shorter than those of the laparoscopic resection;there were no significant differences in complete resection rete(Log OR=-0.97,95%CI=-3.25,1.31,P=0.41),fluid recovery time(SMD=-0.21,95%CI=-0.91,0.49,P=0.56),postoperative hospital stay(MD=-1.02,95%CI=-3.60,1.56,P=0.44),complication rate(Log Peto's OR=0.72,95%CI=-0.41,1.86,P=0.21),and recurrence rate(Log Peto's OR=0.75,95%CI=-0.48,1.96,P=0.23).3.For tumors larger than 5 cm in diameter,endoscopic resection is superior to laparoscopic resection in terms of surgical time(MD=-42.18,95%CI=-53.70,-30.66,P<0.001),postoperative laxative time(SMD=-1.90,95%CI=-2.51,-1.29,P<0.001),fluid recovery time(SMD=-1.76,95%CI=-2.35,-1.16,P<0.001),postoperative hospital stay(MD=-2.22,95%CI=-2.79,-1.65,P<0.001),complication rate(Log Peto's OR=-1.98,95%CI=-3.02,-0.93,P<0.001),and recurrence rate(Log Peto's OR=-1.80,95%CI=-2.83,-0.77,P<0.001).Conclusion:1.Endoscopic resection of gastric stromal tumors with a diameter of less than 2cm has the advantages of short operation time,less intraoperative bleeding,and rapid recovery of gastrointestinal function.The complete resection rate,complication rate,and recurrence rate are similar to those of laparoscopic resection.2.For gastric stromal tumors with a diameter of 2-5cm,endoscopic resection is superior to laparoscopy in terms of shortening the operation time and reducing intraoperative bleeding,postoperative gastrointestinal function recovery,complication rate,and recurrence rate were not significantly different from laparoscopic resection.3.For gastric stromal tumors greater than 5 cm in diameter,endoscopic resection is shorter than laparoscopic resection in terms of operation time,postoperative gastrointestinal function recovery,and postoperative hospitalization.The complication and recurrence rate are smaller than that of laparoscopic resection.