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Development and validation of a preoperative difficulty scoring system for endoscopic resection of gastric gastrointestinal stromal tumor: a multi-center study

BACKGROUND: Endoscopic resection (ER) is a promising technique for resecting gastric gastrointestinal stromal tumors (gGISTs); however, ER is technically challenging. This study aimed to develop and validate a difficulty scoring system (DSS) to determine the difficulty for ER of a gGIST. METHODS: Th...

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Autores principales: Liu, Luojie, Han, Mei, Shi, Dongtao, Wang, Qinghua, Feng, Yunfu, Lu, Fenying, Li, Rui, Xu, Xiaodan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10338596/
https://www.ncbi.nlm.nih.gov/pubmed/37193892
http://dx.doi.org/10.1007/s00464-023-10106-w
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author Liu, Luojie
Han, Mei
Shi, Dongtao
Wang, Qinghua
Feng, Yunfu
Lu, Fenying
Li, Rui
Xu, Xiaodan
author_facet Liu, Luojie
Han, Mei
Shi, Dongtao
Wang, Qinghua
Feng, Yunfu
Lu, Fenying
Li, Rui
Xu, Xiaodan
author_sort Liu, Luojie
collection PubMed
description BACKGROUND: Endoscopic resection (ER) is a promising technique for resecting gastric gastrointestinal stromal tumors (gGISTs); however, ER is technically challenging. This study aimed to develop and validate a difficulty scoring system (DSS) to determine the difficulty for ER of a gGIST. METHODS: This retrospective study enrolled 555 patients with gGISTs in multi-centers from December 2010 to December 2022. Data on patients, lesions, and outcomes of ER were collected and analyzed. A difficult case was defined as an operative time ≥ 90 min, or the occurrence of severe intraoperative bleeding, or conversion to laparoscopic resection. The DSS was developed in the training cohort (TC) and validated in the internal validation cohort (IVC) and external validation cohort (EVC). RESULTS: The difficulty occurred in 97 cases (17.5%). The DSS comprised the following: tumor size ≥ 3.0 cm (3 points) or 2.0–3.0 cm (1 point); location in the upper third of the stomach (2 points); invasion depth beyond the muscularis propria (2 points); lack of experience (1 point). The area under the curve (AUC) of DSS in IVC and EVC was 0.838 and 0.864, respectively, and the negative predictive value (NPV) was 0.923 and 0.972, respectively. The proportions of difficult operation in easy (score 0–3), intermediate (score 4–5), and difficult (score 6–8) categories were 6.5%, 29.4%, and 88.2% in the TC, 7.7%, 45.8%, and 85.7% in the IVC, and 7.0%, 29.4%, and 85.7% in the EVC, respectively. CONCLUSIONS: We developed and validated a preoperative DSS for ER of gGISTs based on tumor size, location, invasion depth, and endoscopists’ experience. This DSS can be used to grade the technical difficulty before surgery. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00464-023-10106-w.
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spelling pubmed-103385962023-07-14 Development and validation of a preoperative difficulty scoring system for endoscopic resection of gastric gastrointestinal stromal tumor: a multi-center study Liu, Luojie Han, Mei Shi, Dongtao Wang, Qinghua Feng, Yunfu Lu, Fenying Li, Rui Xu, Xiaodan Surg Endosc Article BACKGROUND: Endoscopic resection (ER) is a promising technique for resecting gastric gastrointestinal stromal tumors (gGISTs); however, ER is technically challenging. This study aimed to develop and validate a difficulty scoring system (DSS) to determine the difficulty for ER of a gGIST. METHODS: This retrospective study enrolled 555 patients with gGISTs in multi-centers from December 2010 to December 2022. Data on patients, lesions, and outcomes of ER were collected and analyzed. A difficult case was defined as an operative time ≥ 90 min, or the occurrence of severe intraoperative bleeding, or conversion to laparoscopic resection. The DSS was developed in the training cohort (TC) and validated in the internal validation cohort (IVC) and external validation cohort (EVC). RESULTS: The difficulty occurred in 97 cases (17.5%). The DSS comprised the following: tumor size ≥ 3.0 cm (3 points) or 2.0–3.0 cm (1 point); location in the upper third of the stomach (2 points); invasion depth beyond the muscularis propria (2 points); lack of experience (1 point). The area under the curve (AUC) of DSS in IVC and EVC was 0.838 and 0.864, respectively, and the negative predictive value (NPV) was 0.923 and 0.972, respectively. The proportions of difficult operation in easy (score 0–3), intermediate (score 4–5), and difficult (score 6–8) categories were 6.5%, 29.4%, and 88.2% in the TC, 7.7%, 45.8%, and 85.7% in the IVC, and 7.0%, 29.4%, and 85.7% in the EVC, respectively. CONCLUSIONS: We developed and validated a preoperative DSS for ER of gGISTs based on tumor size, location, invasion depth, and endoscopists’ experience. This DSS can be used to grade the technical difficulty before surgery. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00464-023-10106-w. Springer US 2023-05-16 2023 /pmc/articles/PMC10338596/ /pubmed/37193892 http://dx.doi.org/10.1007/s00464-023-10106-w Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
Liu, Luojie
Han, Mei
Shi, Dongtao
Wang, Qinghua
Feng, Yunfu
Lu, Fenying
Li, Rui
Xu, Xiaodan
Development and validation of a preoperative difficulty scoring system for endoscopic resection of gastric gastrointestinal stromal tumor: a multi-center study
title Development and validation of a preoperative difficulty scoring system for endoscopic resection of gastric gastrointestinal stromal tumor: a multi-center study
title_full Development and validation of a preoperative difficulty scoring system for endoscopic resection of gastric gastrointestinal stromal tumor: a multi-center study
title_fullStr Development and validation of a preoperative difficulty scoring system for endoscopic resection of gastric gastrointestinal stromal tumor: a multi-center study
title_full_unstemmed Development and validation of a preoperative difficulty scoring system for endoscopic resection of gastric gastrointestinal stromal tumor: a multi-center study
title_short Development and validation of a preoperative difficulty scoring system for endoscopic resection of gastric gastrointestinal stromal tumor: a multi-center study
title_sort development and validation of a preoperative difficulty scoring system for endoscopic resection of gastric gastrointestinal stromal tumor: a multi-center study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10338596/
https://www.ncbi.nlm.nih.gov/pubmed/37193892
http://dx.doi.org/10.1007/s00464-023-10106-w
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