Endoscopic vs. Surgical resection for gastric gastrointestinal stromal tumors <5cm in size: Systematic review and meta-analysis
Kamal F, Khan MA, Talat A, Gilman C, Arshad HMS, Haq KF, Khan S, Ahmad D, and Tombazzi C. Endoscopic vs. Surgical resection for gastric gastrointestinal stromal tumors <5cm in size: Systematic review and meta-analysis. Gastrointestinal Endoscopy 2020; 91(6):AB594.
Background: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of gastrointestinal (GI) tract. Stomach is the most common site of GISTs. Endoscopic resection of gastric GISTs is being increasingly performed. Some studies have compared outcomes of endoscopic vs surgical resection of gastric GISTs. Aim: To compare outcomes of endoscopic vs surgical resection of gastric GISTs by systematic review and meta-analysis. Methods: We reviewed Pubmed, Scopus, Cochrane and Web of Science from inception to November 2019 to identify studies comparing endoscopic and surgical resection in the management of gastric GISTs <5cm in size. The outcomes assessed included; complications, recurrence rate, rate of R0 resection (defined by removal of entire tumor with negative margins), length of hospital stay and operative time. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated for categorical variables and Standardized mean difference (SMD) with 95% CI were calculated for continuous variables. Data were analyzed using random effects model. Heterogeneity was assessed using I2 statistic. Results: We included 7 studies with 963 patients. 578 patients underwent endoscopic resection and 385 patients underwent surgical resection of gastric GISTs. Results are summarized in table 1. There was no difference in rate of complications between two groups; pooled OR (95% CI): 0.65 (0.29, 1.46). 2 studies reported data on R0 resection rate, and it was better with surgical resection; pooled OR (95% CI): 0.03 (0, 0.21). Length of hospital stay and operative times were significantly shorter in endoscopy group (Figure 1A and B). There was no difference in tumor recurrence rate between two groups; pooled OR (95% CI): 0.66 (0.13, 3.20). Conclusions: Length of hospital stay and operative times are shorter with endoscopic resection of gastric GISTs <5cm in size without increased risk of complications compared to surgical resection. Limited amount of data showed better R0 resection rate with surgical resection. Further studies are required to confirm these findings.