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Goldilocks principle of minimally invasive surgery for gastric subepithelial tumors

World Journal of Gastrointestinal Surgery 2023年第8期15卷 1629-1640页

作者： Wei-Jung Chang Lien-Cheng Tsao Hsu-Heng Yen Chia-Wei Yang Hung-Chi Chang Chew-Teng Kor Szu-Chia Wu Kuo-Hua Lin Department of General Surgery Changhua Christian HospitalChanghua 50006TaiwanChina Department of Gastroenterology Changhua Christian HospitalChanghua 50006TaiwanChina General Education Center Chienkuo Technology UniversityChanghua 50006TaiwanChina School of Medicine Chung Shan Medical UniversityTaichung 40201TaiwanChina Big Data Center Changhua Christian HospitalChanghua 50006TaiwanChina Graduate Institute of Statistics and Information Science National Changhua University of EducationChanghua 50007TaiwanChina Transplant Medicine&Surgery Research Center Changhua Christian HospitalChanghua 50006TaiwanChina

BACKGROUND Minimally invasive surgery had been tailored to individual cases of gastric subepithelial tumors(SETs)after comparing the clinical outcomes of endoscopic resection(ER),laparoscopic resection(LR),and hybrid *** To study the use of Goldilocks principle to determine the best form of minimally invasive surgery for gastric *** In this retrospective study,194 patients of gastric SETs with high probability of surgical intervention were *** patients underwent tumor resection in the operating theater between January 2013 and December *** patients were divided into two groups,ER or LR,according to the tumor characteristics and the initial intent of *** patients in the ER group required further backup laparoscopic surgery after an incomplete *** patients who had converted open surgery were excluded.A logistic regression model was used to assess the associations between patient characteristics and the likelihood of a treatment *** area under the curve was used to assess the discriminative ability of tumor size and Youden’s index to determine the optimal cut-off tumor *** One-hundred ninety-four patients(100 in the ER group and 94 in the LR group)underwent tumor resection in the operating *** the ER group,27 patients required backup laparoscopic surgery after an incomplete *** patients in the ER group had small tumor sizes and shorter procedure durations while the patients in the LR group had large tumor sizes,exophytic growth,malignancy,and tumors that were more often located in the middle or lower third of the *** groups had similar durations of hospital stays and a similar rate of major postoperative *** patients in the ER group who underwent backup surgery required longer procedures(56.4 min)and prolonged stays(2 d)compared to the patients in the LR group without the increased rate of major postoperative *** optimal cut-off point for the tumor size for l

关键词： gastric subepithelial tumors Endoscopic resection Laparoscopic resection Tumor size

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The efficacy of full-thickness endoscopic resection of subepithelial tumors in the gastric cardia

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World Journal of Gastrointestinal Oncology 2023年第12期15卷 2111-2119页

作者： En-Pan Xu Zhi-Peng Qi Bing Li Zhong Ren Ming-Yan Cai Shi-Lun Cai Zhen-Tao Lyv Zhang-Han Chen Jing-Yi Liu Qiang Shi Yun-Shi Zhong Endoscopy Center Zhongshan Hospital Fudan UniversityShanghai 200032China

BACKGROUND gastric subepithelial tumors(SETs)may harbor potential *** it is well recognized that large SETs should be resected,the precise treatment strategy remains *** to surgical resection,endoscopic resection(ER)has many advantages;however,ER of SETs in the cardia is *** To evaluate the safety and efficacy of endoscopic full-thickness resection(EFTR)for the treatment of gastric cardia *** We retrospectively reviewed data from all patients with SETs originating from the muscularis propria layer in the gastric cardia that were treated by EFTR or submucosal tunneling ER(STER)at Zhongshan Hospital Fudan University between November 2014 and May *** characteristics and clinical outcomes,including procedure times and complications rates,were compared between groups of patients receiving EFTR and *** A total of 171 tumors were successfully removed[71(41.5%)tumors in the EFTR and 100(58.5%)tumors in the STER group].Gastrointestinal stromal tumors(GISTs)were the most common *** en bloc resection rate was 100%in the EFTR group vs 97.0%in STER group(P>0.05).Overall,the EFTR group had a higher complete resection rate than the STER group(98.6%vs 91.0%,Pgastric cardia SETs is a very promising method to facilitate complete resection with similar complications and reduced operative times compared to *** cases of suspected GISTs or an unclear diagnosis,EFTR should be recommended to ensure complete resection.

关键词： Endoscopic full-thickness resection Submucosal tunneling endoscopic resection Gastrointestinal stromal tumor gastric cardia gastric subepithelial tumors

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