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Safety analysis of laparoscopic endoscopic cooperative surgery versus endoscopic submucosal dissection for selected gastric gastrointestinal stromal tumors: a propensity score-matched study

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Abstract

Background

Laparoscopic endoscopic cooperative surgery (LECS) is a safe alternative to endoscopic submucosal dissection (ESD) for select gastric gastrointestinal stromal tumors (GISTs) that are <2 cm in size. To date, there have been no randomized studies comparing the feasibility of these two techniques. Therefore, we compared their feasibility and safety using the propensity score matching method in this study.

Methods

This was a single-center, retrospective, propensity score-matched study of patients who underwent resection of selected gastric GISTs between 2004 and 2014. All patients underwent curative resection for pathologically diagnosed small gastric GISTs. The primary aim was to determine intraoperative complications and postoperative courses. To overcome selection biases, we performed a 1:1 match using five covariates, including age, gender, body mass index, Charlson comorbidity index, and tumor location, to generate propensity scores.

Results

In total, 32 patients treated with LECS and 102 patients treated with ESD were balanced into 30 pairs. The rate of intraoperative complications was significantly lower in the LECS group than in the ESD group (P = 0.029). LECS patients had less intraoperative bleeding than did ESD patients (15.0 ml [range 9.5–50.0 ml] vs. 43.5 ml [range 22.3–56.0 ml], P = 0.004). The two groups had similar postoperative courses. There was no difference in the reoperation rate between the two groups (P = 0.112). The ESD group had a shorter operating time than did the LECS group (41.5 min vs. 96.5 min, P < 0.001). However, during a follow-up of 57.9 (±28.9) months, the recurrence rate did not differ significantly between the two groups (0.0 vs. 6.7 %, respectively; P = 0.256).

Conclusions

LECS for selected gastric GIST patients is feasible and is associated with a better intraoperative outcome and an equal postoperative course compared with the results of ESD.

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Acknowledgments

This work was supported by the National High Technology Research and Development Program (863 Program) issued by the Ministry of Science and Technology of China, No. 2012AA011103; The Development Center for Medical Science and Technology, the Ministry of Health of China, No. W2011 WAI44; the Major Program of Science and Technology Program of Guangzhou, No. 201300000087; the Research Fund of Public Welfare in Health Industry, Health Ministry of China, No. 201402015; and the Key Clinical Specialty Discipline Construction Program.

Authors’ contributions

Study conception and design: A. I. Balde, Guoxin Li. Collection of the data: A. I. Balde, J. D. Redondo N. Statistical analysis: A. I. Balde, Hao Liu. Data interpretation: A. I. Balde. Drafting of the manuscript: A. I. Balde, Tao Chen, Yanfeng Hu. Critical revision: Guoxin Li, Li Zhen, Wei Gong, Jiang Yu.

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    Authors and Affiliations

    1. Department of General Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, China

      A. I. Balde, Tao Chen, Yanfeng Hu, J. D. Redondo N., Hao Liu, Jiang Yu, Li Zhen & Guoxin Li

    2. Department of Digestive Endoscopy, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong Province, China

      Wei Gong

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    Drs. A. I. Balde, Tao Chen, Yanfeng Hu, J. D. Redondo N., Hao Liu, Wei Gong, Jiang Yu, Li Zhen, and Guoxin Li have no conflicts of interest or financial ties to disclose.

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    Balde A.I. and Tao Chen contributed equally to this work, including the design of the study and the preparation of the manuscript, and should be considered as co-first authors.

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    Balde, A.I., Chen, T., Hu, Y. et al. Safety analysis of laparoscopic endoscopic cooperative surgery versus endoscopic submucosal dissection for selected gastric gastrointestinal stromal tumors: a propensity score-matched study. Surg Endosc 31, 843–851 (2017). https://doi.org/10.1007/s00464-016-5042-3

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