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Outcomes of Local Excision Compared to Radical Excision of Rectal Gastrointestinal Stromal Tumors: A Propensity-Score Matched Analysis of the NCDB

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Abstract

Background

Gastrointestinal stromal tumors (GISTs) account for <1% of gastrointestinal cancers. The present study aimed to assess the outcomes of local and radical excision of non-metastatic rectal GISTs.

Methods

This study was a retrospective cohort analysis of patients with non-metastatic rectal GISTs in the NCDB. Patients were divided according to the surgical approach into local and radical excision and were compared in regard to the baseline characteristics and outcomes. A propensity-score matched analysis was performed to match the two groups for baseline confounders. The main outcomes were 5-year overall survival (OS), surgical margins, hospital stay, short-term mortality, and readmission.

Results

228 patients (54.8% male) with rectal GISTs were included. Before matching, 127 (55.7%) patients underwent local excision and 101 (44.3%) had radical excision. Patients who underwent local excision had more cT1-T2 and low-grade GISTs whereas patients who had radical excision received more neoadjuvant systemic treatment. After matching for clinical T stage, tumor grade, and neoadjuvant systemic therapy, 52 patients were included in each group. Local excision had a significantly higher rate of positive resection margins (42.2% vs. 19.1%, p = 0.02) and a shorter hospital stay (0 vs. 3 days, p < 0.001) than radical excision. The two groups had similar mean OS (139.8 vs. 133.1 months, p = 0.52).

Conclusions

Local excision was associated with a significantly higher incidence of positive resection margins and shorter hospital stay, yet similar overall survival to radical excision.

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Funding

SDW receives consulting fees for ARC/Corvus, Baxter, GI Supply, ICON Clinical Research Limited, Intuitive Surgical, Leading BioSciences/PalisadeBio, Livsmed, Medtronic, Stryker, Takeda and royalties from Intuitive Surgical, Karl Storz Endoscopy America Inc, Medtronic, Unique Surgical Innovations LLC.

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Authors and Affiliations

  1. Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, USA

    Sameh Hany Emile, Nir Horesh, Michael R. Freund, Zoe Garoufalia, Rachel Gefen, Emanuela Silva-Alvarenga & Steven D. Wexner

  2. Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt

    Sameh Hany Emile

  3. Department of Surgery and Transplantations, Sheba Medical Center (Affiliated with the Tel Aviv University), Ramat Gan, Israel

    Nir Horesh

  4. Department of General Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel

    Michael R. Freund

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  1. Sameh Hany Emile
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Correspondence to Steven D. Wexner.

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Emile, S.H., Horesh, N., Freund, M.R. et al. Outcomes of Local Excision Compared to Radical Excision of Rectal Gastrointestinal Stromal Tumors: A Propensity-Score Matched Analysis of the NCDB. World J Surg 47, 269–277 (2023). https://doi.org/10.1007/s00268-022-06778-5

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