Clinical evaluation of endoscopic resection for treatment of large gastric stromal tumors

BACKGROUND: Gastric stromal tumor is a digestive tract mesenchymal tumor with malignant potential, and endoscopic techniques have been widely used in the treatment of gastric stromal tumors, but there is still controversy over their use for large gastric stromal tumors (≥ 3 cm). AIM: To evaluate the clinical long-term efficacy and safety of endoscopic resection for large (≥ 3 cm) gastric stromal tumors. METHODS: All patients who underwent endoscopic resection or surgery at our hospital from 2012 to 2017 for pathologically confirmed gastric stromal tumor with a maximum diameter of ≥ 3 cm were collected. The clinical data, histopathologic characteristics of the tumors, and long-term outcomes were recorded. RESULTS: A total of 261 patients were included, including 37 patients in the endoscopy group and 224 patients in the surgical group. In the endoscopy group, the maximum tumor diameter was 3-8 cm; the male: Female ratio was 21/16; 34 cases had low-risk tumors, 3 had intermediate-risk, and 0 had high-risk; the mean follow-up time was 30.29 ± 19.67 mo, no patient was lost to follow-up, and no patient received chemotherapy after operation; two patients with recurrence had low-risk stromal tumors, and neither had complete resection under endoscopy. In the surgical group, the maximum tumor diameter was 3-22 cm; the male: Female ratio was 121/103; 103 cases had low-risk tumors, 75 had intermediate-risk, and 46 had high-risk; the average follow-up time was 38.83 ± 21.50 mo, 53 patients were lost to follow-up, and 8 patients had recurrence after operation (6 cases had high-risk tumors, 1 had intermediate-risk, and 1 had low-risk). The average tumor volume of the endoscopy group was 26.67 ± 26.22 cm(3) (3.75-120), all of which were less than 125 cm(3). The average volume of the surgical group was 273.03 ± 609.74 cm(3) (7-4114). Among all patients with a tumor volume < 125 cm(3), 7 with high-risk stromal tumors in the surgical group (37.625 cm(3) to 115.2 cm(3)) accounted for 3.8% (7/183); of those with a tumor volume < 125 cm(3), high-risk patients accounted for 50% (39/78). We found that 57.1% (12/22) of patients with high-risk stromal tumors also had endoscopic surface ulcer bleeding and tumor liquefaction on ultrasound or abdominal computed tomography; the ratio of tumors positive for both in high-risk stromal tumors with a volume < 125 cm(3) was 60% (3/5). CONCLUSION: Endoscopic treatment is safe for 95.5% of patients with gastric stromal tumors with a tumor diameter ≥ 3 cm and a volume of < 125 cm(3) without endoscopic surface ulcer bleeding or CT liquefaction.