Comparison between laparoscopic and endoscopic resections for gastric submucosal tumors

Abstract

Background/Aims: Open resection/laparoscopic resection (LR) is the traditional treatment of gastric submucosal tumor (G-SMT). The endoscopic resection (ER) technology provides good results for G-SMT treatment but lacks sufficient evidence-based evidence. This retrospective study aimed to compare the clinical efficacy of ER [endoscopic submucosal dissection (ESD), endoscopic submucosal excavation (ESE), and endoscopic full-thickness resection (EFR)] and LR [laparoscopic wedge resection (LWR) and laparoscopic subtotal gastrectomy (LSG)] for G-SMT. Patients and Methods: From January 2013 to January 2017, data of patients with G-SMT with tumor diameter <5 cm were collected from the database of The Affiliated Hospital of Qingdao University and classified based on surgical methods. Demographics, tumor characteristics, surgical outcomes, complications and tumor recurrence were recorded and compared. Results: Overall, 275 patients with G-SMT were enrolled: 152 underwent ER (ESD, n = 65; ESE, n = 23; EFR, n = 61) and 123 underwent LR (LWR, n = 93; LSG, n = 30). Age, sex, R0 resection rate, tumor location, type, recurrence and complications were not statistically significant ( P > 0.05). The ER group had a significantly higher percentage of intraluminal tumor (94.1% vs 62.4%) and smaller tumor size (1.8 ± 0.8 vs 3.4 ± 1.2 cm) than the LR group. The ER group had less muscular tumors than the LR group (54.6% vs 70.7%). The ER group had no serosal tumor. The ER group had shorter hospitalization time, postoperative hospital stay and diet recovery time. The LR group had shorter operation time, less cost and less blood loss. Conclusion: ER and LR are safe and effective treatments for SMT. For small intraluminally growing SMT, ER is better than LR.

Factors predicting technical difficulties during endoscopic submucosal excavation for gastric submucosal tumor

“…2 , 6 Endoscopic resection has several advantages over surgical methods, such as it is minimally invasive, associated with a shorter hospital stay, and has a lower cost. 6 – 9 Available endoscopic methods include endoscopic submucosal dissection (ESD), endoscopic submucosal excavation (ESE), endoscopic full-thickness resection (EFTR), and submucosal tunneling endoscopic resection (STER). 10 , 11 ESD is only recommended for SMTs that originate from the superficial muscularis propria (MP) layer.…”

Endoscopic Removal of Gastrointestinal Stromal Tumors in the Stomach: A Single-Center Experience

“…EUS and CT can be employed to assess growth patterns of the tumor and the relationship between tumor sites and MP layer, which are also used to assess the feasibility of ER [8, 9]. When the tumor is mainly convex to the enterocelia, it is difficult to perform ER [35]. It is also difficult to determine an appropriate resection line using a laparoscope, especially for intragastric and intramural GISTs [14].…”

The Feasibility and Safety of the Clip-and-Snare Method with a Prelooping Technique for Gastric Submucosal Tumors Removal: A Single-Center Experience (with Video)

“…The laparoscopic modalities include laparoscopic intragastric surgery (LIGS), laparoscopic wedge resection (LWR), and laparoscopic subtotal gastrectomy (LSG), while endoscopic modalities include endoscopic submucosal dissection (ESD), endoscopic submucosal excavation (ESE), and endoscopic full-thickness resection (EFTR) [ 1 , 13 ]. However, many studies have discovered that ESD had less invasion, shorter procedure duration, less pain, less gastric tissue resection, less bleeding, and lower cost compared with laparoscopic resection (LR) for small (less than 5 cm) and intraluminal gSMTs [ 14 , 15 ].…”

“…e laparoscopic modalities include laparoscopic intragastric surgery (LIGS), laparoscopic wedge resection (LWR), and laparoscopic subtotal gastrectomy (LSG), while endoscopic modalities include endoscopic submucosal dissection (ESD), endoscopic submucosal excavation (ESE), and endoscopic fullthickness resection (EFTR) [1,13]. However, many studies have discovered that ESD had less invasion, shorter procedure duration, less pain, less gastric tissue resection, less bleeding, and lower cost compared with laparoscopic resection (LR) for small (less than 5 cm) and intraluminal gSMTs [14,15]. e clip-and-snare method with a prelooping technique (CSM-PLT), as a traction method, is initially used for resection of early gastric cancer during gastric ESD, which had several advantages, such as shortened procedure duration, decreased bleeding, and obtained good visibility [16,17].…”