Clinical Efficacy and Safety of Endoscopic Treatment of Gastrointestinal Stromal Tumors in the Stomach
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background/Aims: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the stomach. We evaluated the clinical outcomes of endoscopic treatment for gastric GISTs. Methods: This is a single center, retrospective study that enrolled 135 cases of gastric subepithelial tumors (SETs) resected by endoscopic procedures and confirmed as GISTs by histopathology from March 2005 to July 2019. The immediate and long-term clinical outcomes were analyzed retrospectively. Results: The mean patient age was 57.9 years, and the mean tumor size was 2.1 cm. Of the tumors, 43.0% were located in the body, followed by the fundus (26.7%) and cardia (17.0%). Most tumors (85.2%) were resected by endoscopic submucosal dissection, followed by endoscopic mucosal resection (6.7%), submucosal tunneling endoscopic resection (5.9%), and endoscopic full-thickness resection (2.2%). Macroperforation occurred in 4.4% and microperforation in 6.7% of the cases. The R0 resection rate was 15.6%. However, the rate of complete resection by the endoscopic view was 90.4%, of which 54.8% of cases were in the very-low-risk group, followed by the low-risk group (28.1%), intermediate-risk group (11.9%), and high-risk group (5.2%). During 36.5 months of follow-up, recurrence was found in four (3.4%) of the 118 patients who were monitored for more than 6 months (low-risk group, 1/37 [2.7%]; intermediate-risk group, 2/11 [18.2%]; high-risk group, 1/6 [16.7%]). Conclusions: Endoscopic treatment of a GIST appears to be a feasible procedure in selected cases. However, additional surgery should be considered if the pathologic results correspond to intermediate- or high-risk groups.
Abstract
Background/Aims: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the stomach. We evaluated the clinical outcomes of endoscopic treatment for gastric GISTs. Methods: This is a single center, retrospective study that enrolled 135 cases of gastric subepithelial tumors (SETs) resected by endoscopic procedures and confirmed as GISTs by histopathology from March 2005 to July 2019. The immediate and long-term clinical outcomes were analyzed retrospectively. Results: The mean patient age was 57.9 years, and the mean tumor size was 2.1 cm. Of the tumors, 43.0% were located in the body, followed by the fundus (26.7%) and cardia (17.0%). Most tumors (85.2%) were resected by endoscopic submucosal dissection, followed by endoscopic mucosal resection (6.7%), submucosal tunneling endoscopic resection (5.9%), and endoscopic full-thickness resection (2.2%). Macroperforation occurred in 4.4% and microperforation in 6.7% of the cases. The R0 resection rate was 15.6%. However, the rate of complete resection by the endoscopic view was 90.4%, of which 54.8% of cases were in the very-low-risk group, followed by the low-risk group (28.1%), intermediate-risk group (11.9%), and high-risk group (5.2%). During 36.5 months of follow-up, recurrence was found in four (3.4%) of the 118 patients who were monitored for more than 6 months (low-risk group, 1/37 [2.7%]; intermediate-risk group, 2/11 [18.2%]; high-risk group, 1/6 [16.7%]). Conclusions: Endoscopic treatment of a GIST appears to be a feasible procedure in selected cases. However, additional surgery should be considered if the pathologic results correspond to intermediate- or high-risk groups.
참고문헌 (37)
- Chak A, "Endosonographic differentiation of benign and malignant stromal cell tumors", Gastrointest Endosc, 45, pp.468~473 (1997)
- Palazzo L, "Endosonographic features predictive of benign and malignant gastrointestinal stromal cell tumours", Gut, 46, pp.88~92 (2000)
- Brand B, "Impact of endoscopic ultrasound for evaluation of submucosal lesions in gastrointestinal tract", Dig Liver Dis, 34, pp.290~297 (2002)
- Biondi A, "R0 resection in the treatment of gastric cancer : room for improvement", World J Gastroenterol, 16, pp.3358~3370 (2010)
- DeMatteo RP, "Two hundred gastrointestinal stromal tumors : recurrence patterns and prognostic factors for survival", Ann Surg, 231, pp.51~58 (2000)
- 구동회, "Asian Consensus Guidelines for the Diagnosis and Management of Gastrointestinal Stromal Tumor", Cancer Research and Treatment, 48(4), pp.1155~1166 (2016), 대한암학회
- Standards of Practice Committee, "The role of endoscopy in subepithelial lesions of the GI tract", Gastrointest Endosc, 85, pp.1117~1132 (2017)
- "NCCN Clinical Practice Guideline in Oncology: Gastrointestinal Stromal Tumors (GISTs) version 1" (2021)[URL]
- Demetri GD, "NCCN Task Force report : update on the management of patients with gastrointestinal stromal tumors", J Natl Compr Canc Netw, 8(Suppl 2), pp.S1~S41 (2010)
- De Vogelaere K, "Laparoscopic versus open resection of gastrointestinal stromal tumors of the stomach", Surg Endosc, 27, pp.1546~1554 (2013)
- An W, "Endoscopic submucosal dissection for gastric gastrointestinal stromal tumors : a retrospective cohort study", Surg Endosc, 31, pp.4522~4531 (2017)
- Pang T, "Comparison of safety and outcomes between endoscopic and surgical resections of small(≤ 5 cm)primary gastric gastrointestinal stromal tumors", J Cancer, 10, pp.4132~4141 (2019)
- Dai WJ, "Endoscopic versus laparoscopic resection of gastric gastrointestinal stromal tumors : a multicenter study", Oncotarget, 8, pp.11259~11267 (2017)
- Joo MK, "Endoscopic versus surgical resection of GI stromal tumors in the upper GI tract", Gastrointest Endosc, 83, pp.318~326 (2016)
- Fletcher CD, "Diagnosis of gastrointestinal stromal tumors : a consensus approach", Hum Pathol, 33, pp.459~465 (2002)
- Ahn JY, "Endoscopic and oncologic outcomes after endoscopic resection for early gastric cancer : 1370 cases of absolute and extended indications", Gastrointest Endosc, 74, pp.485~493 (2011)
- Meng Y, "Long-term outcomes of endoscopic submucosal dissection versus laparoscopic resection for gastric stromal tumors less than 2 cm", J Gastroenterol Hepatol, 32, pp.1693~1697 (2017)
- He Z, "Endoscopic submucosal dissection of large gastrointestinal stromal tumors in the esophagus and stomach", J Gastroenterol Hepatol, 28, pp.262~267 (2013)
- Andalib I, "Endoscopic resection of gastric gastrointestinal stromal tumors originating from the muscularis propria layer in North America : methods and feasibility data", Surg Endosc, 32, pp.1787~1792 (2018)
- Tan Y, "Comparison between submucosal tunneling endoscopic resection and endoscopic full-thickness resection for gastric stromal tumors originating from the muscularis propria layer", Surg Endosc, 31, pp.3376~3382 (2017)
- Huang LY, "Endoscopic therapy for gastric stromal tumors originating from the muscularis propria", World J Gastroenterol, 18, pp.3465~3471 (2012)
- Wang L, "Full-thickness endoscopic resection of nonintracavitary gastric stromal tumors : a novel approach", Surg Endosc, 25, pp.641~647 (2011)
- Chen T, "Management of the complications of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors", Endoscopy, 48, pp.149~155 (2016)
- Hwang JH, "American Gastroenterological Association Institute technical review on the management of gastric subepithelial masses", Gastroenterology, 130, pp.2217~2228 (2006)
- Dumonceau JM, "Indications, results, and clinical impact of endoscopic ultrasound(EUS)-guided sampling in gastroenterology : European Society of Gastrointestinal Endoscopy(ESGE)Clinical Guideline : updated January 2017", Endoscopy, 49, pp.695~714 (2017)
- Khashab MA, "Conquering the third space : challenges and opportunities for diagnostic and therapeutic endoscopy", Gastrointest Endosc, 77, pp.146~148 (2013)
- Casali PG, "Gastrointestinal stromal tumours: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up", Ann Oncol, 29(Suppl 4), pp.iv267~ (2018)
- Jong-Jae Park, "Long-Term Outcomes after Endoscopic Treatment of Gastric Gastrointestinal Stromal Tumor", Clinical Endoscopy, 49(3), pp.232~234 (2016), 대한소화기내시경학회
- Zhang X, "Endoscopic resection for subepithelial lesions-pure endoscopic full-thickness resection and submucosal tunneling endoscopic resection", Transl Gastroenterol Hepatol, 4, pp.39~ (2019)
- Miettinen M, "Gastrointestinal stromal tumors : pathology and prognosis at different sites", Semin Diagn Pathol, 23, pp.70~83 (2006)
- Koga T, "Necessity for resection of gastric gastrointestinal stromal tumors ≤ 20 mm", Anticancer Res, 35, pp.2341~2344 (2015)
- Casali PG, "Gastrointestinal stromal tumours : ESMO clinical recommendations for diagnosis, treatment and follow-up", Ann Oncol, 20(Suppl 4), pp.64~67 (2009)
- Meng Y, "Endoscopic band ligation versus endoscopic submucosal dissection and laparoscopic resection for small gastric stromal tumors", Surg Endosc, 30, pp.2873~2878 (2016)
- Feng F, "Comparison of endoscopic and open resection for small gastric gastrointestinal stromal tumor", Transl Oncol, 8, pp.504~508 (2015)
- Kim HH, "Endoscopic treatment for gastrointestinal stromal tumor : advantages and hurdles", World J Gastrointest Endosc, 7, pp.192~205 (2015)
- Kim MY, "Predictors of recurrence after resection of small gastric gastrointestinal stromal tumors of 5 cm or less", J Clin Gastroenterol, 46, pp.130~137 (2012)
- "NCCN Clinical Practice Guidelines in Oncology: Soft Tissue Sarcoma" (2019)[URL]