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. 2023 Aug 27;15(8):1629-1640.
doi: 10.4240/wjgs.v15.i8.1629.

Goldilocks principle of minimally invasive surgery for gastric subepithelial tumors

Wei-Jung Chang  1 , Lien-Cheng Tsao  1 , Hsu-Heng Yen  2   3   4 , Chia-Wei Yang  2 , Hung-Chi Chang  1 , Chew-Teng Kor  5   6 , Szu-Chia Wu  7 , Kuo-Hua Lin  8
Affiliations

Goldilocks principle of minimally invasive surgery for gastric subepithelial tumors

Wei-Jung Chang et al. World J Gastrointest Surg. .

Abstract

Background: Minimally invasive surgery had been tailored to individual cases of gastric subepithelial tumors (SETs) after comparing the clinical outcomes of endoscopic resection (ER), laparoscopic resection (LR), and hybrid methods.

Aim: To study the use of Goldilocks principle to determine the best form of minimally invasive surgery for gastric SETs.

Methods: In this retrospective study, 194 patients of gastric SETs with high probability of surgical intervention were included. All patients underwent tumor resection in the operating theater between January 2013 and December 2021. The patients were divided into two groups, ER or LR, according to the tumor characteristics and the initial intent of intervention. Few patients in the ER group required further backup laparoscopic surgery after an incomplete ER. The patients who had converted open surgery were excluded. A logistic regression model was used to assess the associations between patient characteristics and the likelihood of a treatment strategy. The area under the curve was used to assess the discriminative ability of tumor size and Youden's index to determine the optimal cut-off tumor size.

Results: One-hundred ninety-four patients (100 in the ER group and 94 in the LR group) underwent tumor resection in the operating theater. In the ER group, 27 patients required backup laparoscopic surgery after an incomplete ER. The patients in the ER group had small tumor sizes and shorter procedure durations while the patients in the LR group had large tumor sizes, exophytic growth, malignancy, and tumors that were more often located in the middle or lower third of the stomach. Both groups had similar durations of hospital stays and a similar rate of major postoperative complications. The patients in the ER group who underwent backup surgery required longer procedures (56.4 min) and prolonged stays (2 d) compared to the patients in the LR group without the increased rate of major postoperative complications. The optimal cut-off point for the tumor size for laparoscopic surgery was 2.15 cm.

Conclusion: Multidisciplinary teamwork leads to the adoption of different strategies to yield efficient clinical outcomes according to the tumor characteristics.

Keywords: Endoscopic resection; Gastric subepithelial tumors; Laparoscopic resection; Tumor size.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Multivariate adjustment factor for the likelihood of patients undergoing laparoscopic surgery compared to endoscopic submucosal dissection patients and endoscopic submucosal dissection with backup surgery. A: Endoscopic submucosal dissection patients; B: Endoscopic submucosal dissection with backup surgery. aOR: adjusted odds ratio; CI: Confidence interval.
Figure 2
Figure 2
Optimal cut-off point for tumor size for laparoscopic surgery. AUROC: Area under the receiver operating characteristic curve.
Figure 3
Figure 3
Comparison of disease-free survival rates and survival rates between the endoscopic and laparoscopic resection groups during long-term surveillance. A: Disease-free survival rates; B: Survival rates. ESD: Endoscopic submucosal dissection.
See this image and copyright information in PMC

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References

    1. Hwang JH, Rulyak SD, Kimmey MB American Gastroenterological Association Institute. American Gastroenterological Association Institute technical review on the management of gastric subepithelial masses. Gastroenterology. 2006;130:2217–2228. - PubMed
    1. Cho JW Korean ESD Study Group. Current Guidelines in the Management of Upper Gastrointestinal Subepithelial Tumors. Clin Endosc. 2016;49:235–240. - PMC - PubMed
    1. Casali PG, Abecassis N, Aro HT, Bauer S, Biagini R, Bielack S, Bonvalot S, Boukovinas I, Bovee JVMG, Brodowicz T, Broto JM, Buonadonna A, De Álava E, Dei Tos AP, Del Muro XG, Dileo P, Eriksson M, Fedenko A, Ferraresi V, Ferrari A, Ferrari S, Frezza AM, Gasperoni S, Gelderblom H, Gil T, Grignani G, Gronchi A, Haas RL, Hassan B, Hohenberger P, Issels R, Joensuu H, Jones RL, Judson I, Jutte P, Kaal S, Kasper B, Kopeckova K, Krákorová DA, Le Cesne A, Lugowska I, Merimsky O, Montemurro M, Pantaleo MA, Piana R, Picci P, Piperno-Neumann S, Pousa AL, Reichardt P, Robinson MH, Rutkowski P, Safwat AA, Schöffski P, Sleijfer S, Stacchiotti S, Sundby Hall K, Unk M, Van Coevorden F, van der Graaf WTA, Whelan J, Wardelmann E, Zaikova O, Blay JY ESMO Guidelines Committee and EURACAN. Gastrointestinal stromal tumours: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018;29:iv68–iv78. - PubMed
    1. von Mehren M, Kane JM, Bui MM, Choy E, Connelly M, Dry S, Ganjoo KN, George S, Gonzalez RJ, Heslin MJ, Homsi J, Keedy V, Kelly CM, Kim E, Liebner D, McCarter M, McGarry SV, Meyer C, Pappo AS, Parkes AM, Paz IB, Petersen IA, Poppe M, Riedel RF, Rubin B, Schuetze S, Shabason J, Sicklick JK, Spraker MB, Zimel M, Bergman MA, George GV. NCCN Guidelines Insights: Soft Tissue Sarcoma, Version 1.2021. J Natl Compr Canc Netw. 2020;18:1604–1612. - PubMed
    1. Koo DH, Ryu MH, Kim KM, Yang HK, Sawaki A, Hirota S, Zheng J, Zhang B, Tzen CY, Yeh CN, Nishida T, Shen L, Chen LT, Kang YK. Asian Consensus Guidelines for the Diagnosis and Management of Gastrointestinal Stromal Tumor. Cancer Res Treat. 2016;48:1155–1166. - PMC - PubMed