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Objective:To construct enhanced computed tomography (CT)-based nomograph model, to assist physicians in differentiating gastric schwannoma from gastric stromal tumor.Methods:From January 1, 2012 to January 1, 2022, at the Second Affiliated Hospital of Zhejiang University School of Medicine and Ningbo Hwamei Hospital, University of Chinese Academy of Sciences, 57 patients with gastric schwannoma and 275 patients with gastric stromal tumor confirmed by surgical pathology were retrospectively collected, among whom 39 patients with gastric schwannoma and 201 patients with gastric stromal tumor were enrolled in the training set, and the other 18 patients with gastric schwannoma and 74 patients with gastric stromal tumor were enrolled in the validation set. The contrast-enhanced CT imaging features (tumor size index, arterial phase CT value, venous phase CT value, necrosis, calcification, integrity of mucosal surface, and uniform enhancement, etc.) and clinical data (history of gastritis, carbohydrate antigen 19-9 (CA19-9), carcinoembryonic antigen, and monocyte to lymphocyte ratio (MLR), etc.) were collected. The least absolute shrinkage and selection operator (LASSO) regression analysis was used to screen the independent predictive factors of imaging features in the differential diagnosis of gastric schwannoma and gastric stromal tumor, and a nomograph model was constracted. Logistic regression analysis was used to analyze and screen the independent predictive factors of clinical indicators to distinguish gastric schwannoma from gastric stromal tumor, and a clinical control model was established. The receiver operating characteristic curve(ROC) was used to analyze the area under the curve (AUC) of the nomograph model in the training set and the verification set, and concordance index (CI) and decision curve analysis (DCA) were used to evaluate the predictive efficiency and clinical application value of the nomograph model. DeLong test was used for statistical analysis.Results:The results of LASSO regression analysis showed that tumor size index, arterial phase CT value, venous phase CT value, necrosis, calcification, integrity of mucosal surface, and uniform enhancement were independent predictive factors of imaging features in the differential diagnosis of gastric schwannoma and gastric stromal tumor(all P<0.05). The results of logistic regression analysis indicated that the history of gastritis ( OR=0.280, 95% confidence interval 0.138 to 0.566), CA19-9 ( OR=0.940, 95% confidence interval 0.890 to 0.993), carcinoembryonic antigen ( OR=0.794, 95% confidence interval 0.661 to 0.952), and MLR ( OR=0.087, 95% confidence interval 0.009 to 0.860) were independent predictive factors of clinical indicators in the differential diagnosis of gastric schwannoma and gastric stromal tumor ( P<0.001, =0.028, 0.013 and 0.037). The AUCs of the nomograph model in the training and validation set were 0.881 and 0.850, respectively, and the AUCs of the clinical control model in the training and validation set were 0.814 and 0.772, respectively, and the differences were statistically significant ( Z=2.57 and 1.96, P=0.005 and 0.030). The average CI of the nomograph model was 0.885. The results of DCA analysis showed that the overall benefit of the nomograph model was higher than that of the clinical control model. Conclusion:The enhanced CT-based nomograph model can effectively distinguish gastric schwannoma from gastric stromal tumor, and can help physicians to make precise clinical decisions.
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Objective:To compare the safety and efficacy of laparoscopy and laparotomy for 5-10 cm intermediate-risk gastric stromal tumor, and to evaluate whether there was evident benefits of postoperative adjuvant treatment with imatinib.Methods:A retrospective study was conducted on 72 patients with moderate risk gastric stromal tumors (5-10 cm in diameter) who received operation in Nanjing Drum Tower Hospital from January 2010 to July 2020. There were 28 cases in the laparoscopy group and 44 cases in the laparotomy group. The clinical features, pathological data, perioperative results and hospitalization costs were compared between the two groups. The survival rates of postoperative adjuvant therapy with or without imatinib were analyzed and compared.Results:There was no significant difference in clinicopathological features between the two groups ( P>0.05). The incidences of postoperative complications in the laparoscopy group and the laparotomy group were 32.1% (9/28) and 52.3% (23/44) respectively, showing no significant difference ( P=0.094). Compared with the laparotomy group, both the hospital stay (12.5±3.2 days VS 15.0±3.5 days, P=0.004) and the median postoperative hospital stay (7.5 days VS 9.0 days, P=0.006) in the laparoscopy group were significantly shorter, and the first exhaust time was significantly shorter ( P=0.003). During the median follow-up period of 58 months (13-129 months), there was no tumor-related death. Two cases died of breast cancer and heart disease in the laparotomy group, and 1 case died irrelevant to gastric stromal tumor in the laparoscopy group. Of the 72 patients, 40 received postoperative imatinib adjuvant therapy, 22 cases (50.0%) in the laparotomy group and 18 cases (64.3%) in the laparoscopy group, with no significant difference in the proportion ( χ2=1.414, P=0.234). There was significant difference in the overall survival rate between the group treated with imatinib and the group without imatinib ( P=0.015). Conclusion:Laparoscopic resection is safe and effective for intermediate-risk gastric stromal tumor of 5-10 cm. Taking imatinib adjuvant treatment does not increase overall survival rate of patients with intermediate-risk gastric stromal tumors (5-10 cm), and there is no tumor-related death, recurrence or metastasis for those who did not accept imatinib adjuvant treatment after R0 resection.
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Objective:To compare surgery-related indicators, patient recovery status, perioperative complications and risk factors affecting the occurrence of postoperative grade Ⅲ or higher complications in patients undergoing laparoscopic gastric mesenchymal tumor surgery with different visceral fat areas.Methods:Clinical data of 116 patients with gastric interstitial tumor in Shaanxi Provincial People′s Hospital from April 2014 to June 2020 were retrospectively analyzed, including 44 male patients and 72 female patients, with patient aged from 25 to 88 years old and the mean age was (61.8±10.7) years, including 54 patients in the high VFA group and 62 patients in the low VFA group. SPSS 23.0 was used for statistical analysis, and t-test and χ2 test were applied to compare and analyze the patients′ surgery-related indexes, postoperative recovery status, complications within 30 d after surgery and differences in Clavien-Dindo classification of complications, while univariate and multifactorial analyses were used to study the factors affecting the occurrence of postoperative grade Ⅲ or higher complications. Results:Patients in the high VFA group had a higher body mass index than in the low VFA group, and the difference was statistically significant ( t=4.48, P<0.001); patients in the high VFA group had longer operative time ( t=2.88, P=0.005), more intraoperative bleeding ( t=2.17, P=0.032), longer period of fasting ( t=2.73, P=0.008), longer time for defecation ( t=4.46, P<0.001) and bowel movement ( t=4.62, P<0.001), and longer postoperative hospital stay ( t=3.43) compared with those in the low VFA group ( t=2.73, P=0.001), prolonged defecation ( t=4.46), prolonged bowel movement ( t=4.62), and prolonged postoperative hospitalization ( t=3.43), with statistically significant differences ( P<0.05); the incidence of postoperative complications was significantly higher in the high VFA group (31.4%) compared with the low VFA group (14.5%) ( χ2=4.78, P=0.029); among them, the incidence of postoperative pulmonary infection was significantly higher in patients in the high VFA group (12.9%) compared with those in the low VFA group (1.6%), and the difference between them was statistically significant ( χ2=4.16, P<0.05); while the differences in postoperative incision-related complications, anastomotic fistula, lower limb venous thrombosis, and intestinal obstruction were not statistically significant ( P>0.05). The incidence of postoperative complications above grade Ⅲ of the Clavien-Dindo complication classification was significantly higher in patients in the high VFA group (16.7%) compared with those in the low VFA group (4.8%), and the difference between the two was statistically significant ( χ2=4.35, P<0.05); univariate analysis revealed that operative time ≥300 min and increased VFA were the risk factors for postoperative grade Ⅲ or higher complications, while VFA was not an independent risk factor. Conclusion:Larger visceral fat area increases the difficulty of laparoscopic gastric mesenchymal tumor surgery operation, and also affects patients′ postoperative recovery, leading to increased postoperative complications, but VFA is not an independent risk factor affecting the occurrence of postoperative grade Ⅲ or higher complications in patients with gastric mesenchymal tumor.
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Objective:To study the safety and effectiveness of endoscopic full-thickness resection(EFR) in the treatment of large gastric stromal tumors with diameter of 5-7 cm.Methods:Data of 36 patients with large gastric stromal tumors (5-7 cm) who received EFR or surgery (including laparoscopic and open surgery) in the First Affiliated Hospital of Zhengzhou University and confirmed by postoperative histopathology from January 2017 to October 2018 were retrospectively analyzed. Patients were divided into endoscopic group (9 cases) and surgical group (27 cases) according to different resection methods. The perioperative indicators and the total incidence of complications in the two groups were compared.Results:In terms of perioperative indicators, the median operation time of the endoscopic group was significantly longer than that of the surgical group (4.0 hours VS 2.0 hours, P<0.01), and the postoperative fasting time (4.55±0.88 days VS 6.22±2.24 days, t=-2.15, P=0.03) and hospital stay (6.88±1.26 days VS 10.03±2.90 days, t=-3.13, P<0.01) were significantly shorter than those of the surgical group. The median visual analogue scores (VAS) of abdominal pain of the endoscopic group on the first postoperative day (3 VS 6, P<0.01)and the third postoperative day (1 VS 3, P<0.01) were significantly lower than those of the surgical group. The hospitalization cost was significantly less than that of the surgical group (55±14.7 thousand yuan VS 73±24.3 thousand yuan, t=-2.11, P=0.04). In term of the total incidence of complications, the endoscopic group was 11.1% (1/9), which was higher than that of the surgical group [7.4% (2/27)], but there was no statistically significant difference( P=1.00). Conclusion:EFR is safe and effective in the treatment of large gastric stromal tumors (5-7 cm), and has the advantages of less invasiveness, rapid postoperative recovery, and lower hospitalization cost. But how to shorten the operation time is an urgent problem to be solved.
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Objective@#To systematically evaluate the efficacy and safety of endoscopic resection and laparoscopic surgery for gastrointestinal stromal tumors(GIST) (diameter<3.5 cm).@*Methods@#According to the Cocharane system search strategy, Chinese and English literature comparing endoscopic with laparoscopic treatment of GIST published from January 2000 to March 2018 were collected. Ten articles meeting the inclusion criteria were included and analyzed with Revman 5.3.@*Results@#Of the 10 articles, 1 was a prospective randomized controlled trial and 9 were retrospective non-randomized controlled trials. The total number of patients was 1 062. There were 732 cases in the endoscopic treatment group, and 330 cases in the laparoscopic surgery group. The meta-analysis results showed that the endoscopic treatment group had shorter operation time (MD=-30.58 min, 95%CI: -39.31--21.84, P<0.05), less blood loss (MD=-12.99 mL, 95%CI: -16.40--9.57, P<0.05), shorter hospital stay (MD=-3.17 d, 95%CI: -4.76--1.59, P<0.05), and less total cost (MD=-1.63 ten thousand RMB, 95%CI: -2.42--0.84, P<0.05) than those of the laparoscopic group. But there were no significant differences in the positive rate of margin(RR=2.35, 95%CI: 0.52-10.69, P=0.27) or perioperative complications(RR=1.08, 95%CI: 0.48-2.42, P=0.85).@*Conclusion@#Existing studies have shown that endoscopic treatment for GIST is effective, minimally invasive, economical with better prognosis, ensuring complete resection.
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Objective To systematically evaluate the efficacy and safety of endoscopic resection and laparoscopic surgery for gastrointestinal stromal tumors(GIST)(diameter<3. 5 cm). Methods According to the Cocharane system search strategy,Chinese and English literature comparing endoscopic with laparoscopic treatment of GIST published from January 2000 to March 2018 were collected. Ten articles meeting the inclusion criteria were included and analyzed with Revman 5. 3. Results Of the 10 articles,1 was a prospective randomized controlled trial and 9 were retrospective non-randomized controlled trials. The total number of patients was 1062. There were 732 cases in the endoscopic treatment group,and 330 cases in the laparoscopic surgery group. The meta-analysis results showed that the endoscopic treatment group had shorter operation time (MD= -30. 58 min,95％CI:-39. 31--21. 84,P<0. 05),less blood loss (MD= -12. 99 mL, 95％CI:- 16. 40-- 9. 57,P < 0. 05),shorter hospital stay (MD = - 3. 17 d,95％CI:-4. 76--1. 59,P <0. 05),and less total cost (MD= -1. 63 ten thousand RMB,95％CI:-2. 42--0. 84,P<0. 05)than those of the laparoscopic group. But there were no significant differences in the positive rate of margin(RR = 2. 35, 95％CI:0. 52-10. 69,P= 0. 27)or perioperative complications(RR= 1. 08,95％CI:0. 48-2. 42,P= 0. 85). Conclusion Existing studies have shown that endoscopic treatment for GIST is effective,minimally invasive,economical with better prognosis,ensuring complete resection.
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Objective To re-evaluate the potential risk of small gastric stromal tumor ( diameter less than 2 cm), and to assess the safety and efficacy of endoscopic resection and further treatment strategy for small gastric stromal tumor. Methods Data of 584 patients undergoing endoscopic submucosal dissection ( ESD) and diagnosed as gastric submucosal tumor ( SMT) in Tianjin Medical University General Hospital from September 2008 to December 2015 were retrospectively analyzed. The clinical and pathological features and potential risk of small gastric stromal tumor were analyzed. The therapeutic outcomes, complications and follow-up results of ESD were summarized, and the follow-up results of patients undergoing ESD were compared with 45 patients who were suspected as small gastric stromal tumor and followed-up regularly by endoscopic ultrasonography ( EUS) in the same period. Results Among 584 cases of gastric SMT, stromal tumor ( 239 cases, 40. 9％) was the most common type, of which small gastric stromal tumor was found in 203 cases (84. 9％, 203/239). The mitotic index of all cases was no more than 5/50 high power field. However, adverse factors under EUS, mainly including strong echo and heterogeneity, were reported in 94 (46. 3％) out of 203 cases and were confirmed to be related to tumor size (P=0. 000). ESD was successfully performed in 203 patients with small gastric stromal tumor, and no serious complication or perioperative death occurred. Symptoms of 81. 4％ ( 144/177 ) patients were improved after ESD, and no stromal tumor recurrence or metastasis was observed during a follow-up of 12-84 months. Of the 45 patients followed-up regularly by EUS, 38 (84. 4％) patients had gastrointestinal symptoms and 84. 2％ (32/38) were not relieved during follow-up, and 12 (26. 7％) had a heavier psychological burden, seriously affecting the quality of life. Conclusion The incidence of adverse factors under EUS is high in patients with small gastric stromal tumor, and increased with tumor size. ESD is safe and effective for small gastric stromal tumor, which contributes to the diagnosis, further improves therapeutic effects and reduces psychological pressure.
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Objective To investigate the feasibility of laparoscopic endoscopic cooperative dissection without mucosa injury for patients with small gastric stromal tumor. Methods Fifteen patients with small gastric stromal tumor underwent laparoscopy and endoscopy combination therapy from January 2015 to October 2016. The gastric serous layer was cut open after submucosal injection, and then tumor was removed without mucosa injury under laparoscope. The clinical data were retrospectively analyzed. Results All of the 15 patients successfully completed the operation,and no one conversed to open surgery because of intraoperative complications. The operation time was 53.4±15.8 min, and the intraoperative blood loss was 15.2±3.5 mL. The gastric tube was pulled out on the day of operation.The mean time of recovering liquid diet after operation was 1.6±0.5 days, and the length of postoperative hospital stay was 3.3 ± 0.6 days. All the specimen had complete pseudocapsule,and their pathology results were all gastric stromal tumors,including 12 cases of very low risk degree, 2 low risk degree, and 1 middle risk degree. Conclusion Laparoscopic endoscopic cooperative dissection for small gastric stromal tumor has satisfactory short-term outcomes and shows a quick postoperative recovery,which meets the idea of minimally invasive surgery and rapid recovery. It is a new choice of treatment for patients with small gastric stromal tumor.
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Objective@#To evaluate the correlation between computed tomography (CT) features and malignancy risk category of small (≤5 cm) gastric stromal tumors (GST), in order to provide an image reference for preoperative assessment and intraoperative pathological diagnosis.@*Methods@#Eighty-three patients with surgically and pathologically proven GST (≤5 cm) between January 2011 and November 2015 were recruited, and their clinical, pathological and CT data were retrospectively analyzed. According to the pathological results and malignancy risk category, the patients were divided into 2 groups, the benign biological behavior group (very low and low risk) and malignant biological behavior group (intermediate and high risk). The clinical, pathological and CT imaging findings of the two groups were analyzed. Based on the tumor diameter, the receiver operating characteristic curve (ROC) was applied to evaluate the sensitivity, specificity and the best cut-off point for distinguishing the malignancy risk between the two groups.@*Results@#The lobulation and ulceration of the tumors presented statistically significant difference for the malignancy risk between the two groups (χ2=6.273 and 4.163, respectively; all P<0.05), but there was no significant difference in the sex, clinical symptoms, serum ferritin, tumor site, growth pattern, cystis degeneration and calcification (all P>0.05). No statistically significant differences were detected for the tumor CT value, arterial CT value, venous CT value, degrees of enhancement in arterial phase (DEAP), enhancement in portal venous phase (DEPP), and patient′s age for distinguishing the malignancy risk between the two groups (all P>0.05). On the other hand, significant differences were found in the maximum diameter (Dmax) of tumor and the minimum diameter (Dmin) of tumor (t=-3.256 and -3.466, respectively; all P<0.05). When the cut-off point of Dmax was 1.6 cm, the area under the ROC curve, sensitivity and specificity were 0.704, 92.3% and 75.4%, respectively. When the cut-off point of Dmin was 1.5 cm, the area under the ROC curve, sensitivity and specificity were 0.713, 88.5% and 71.9%, respectively.@*Conclusion@#CT features of the GST (≤5 cm) may predict, before surgery, the malignancy risk of small gastric stromal tumors, and provide the an image reference for preoperative assessment and intraoperative pathological diagnosis of the disease.
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Objective To investigate the clinical efficacy of laparoscopy combined with gastroscopy in the treatment of gastric stromal tumors.Methods A retrospective analysis was conducted on the clinical data of 30 cases who received gastric gastrointestinal surgery from August 2013 to April 2016.Among the 30 cases,18 cases(Double mirror group)were received surgery by laparoscopy combined with gastroscopy,12 cases (laparotomy group)were underwent traditional open surgery.The general data,operation time,blood loss,hospitalization time,abdominal volume,postoperative complications,hospitalization expenses and 1-year recurrence rate were compared between the two groups.Results There were no deaths in the two groups,and the general data had no significant difference between the two groups (P ＞ 0.05).The bleeding volume,operation time,peritoneal drainage,hospitalization time,hospitalization expenses of the double mirror group were (45.6 ± 12.2) ml,(121.9 ± 24.5) min,(91.2 ± 14.6) ml,(8.4 ± 2.3) d,(34591.2 ± 3434.6) yuan,and those of laparotomy group were (65.6 ± 14.3) ml,(94.7 ± 18.5) min,(117.9 ± 22.5) ml,(11.3 ± 3.4) d,(25374.3 ± 2930.3) yuan,the difference between the two groups was statistically significant(P ＜ 0.05).One case with complications was found in the double mirror group,and the incidence rate was 5.56％.Five cases with complications were found in the laparotomy group,and the incidence rate was 41.67％,the difference was statistically significant(x2 =6.354,P =0.001).After 1 year,three cases ofrecurrences were found in the double mirror group,and 2 cases in the laparotomy group,there was no significant difference between the two groups (x2 =0,P =0.485).Conclusion The method of laparoscopic combined with gastroscopy can give full play to their advantages,and has the advantages of fast and accurate positioning,fast recovery and accuracy curative effect in the resection of gastric stromal tumors.
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Objective To study the clinical application of laparoscope combined with gastroscope surgery in patients with gastric stromal tumor. Methods The clinical data of 50 patients with gastric stromal tumor were retrospectively analyzed. Among them 20 cases were treated with traditional laparotomy (laparotomy group), and 30 cases were treated with laparoscope combined with gastroscope surgery (combination group). The intraoperative bleeding, operation time, postoperative recovery time, postoperative hospitalization time and complications were compared between 2 groups. Results One case in combination group received open surgery (3.33%, 1/30), mainly because of obesity, and tumor rupture occurred in 1 case during operation. All specimens of the 2 groups had no tumor residue. There were no statistical differences in tumor diameter and operation time between 2 groups (P>0.05); the intraoperative bleeding, postoperative recovery time and postoperative hospitalization time in combination group were significantly lower than those in laparotomy group:(26.33 ± 14.21) ml vs. (42.57 ± 15.67) ml, (37.96 ± 8.80) h vs. (60.14 ± 13.41) h and (6.42 ± 2.80) d vs. (12.04 ± 4.69) d, and there were statistical differences (P<0.05). The 2 groups had no death, stomach bleeding, anastomotic stenosis and anastomotic leakage. The laparotomy group had postoperative incision fat liquefaction in 3 cases and incision infection in 2 cases, and the combination group had pulmonary infection in 1 case. All were cured after symptomatic treatment. Conclusions Laparoscope combined with gastroscope surgery in the treatment of gastric stromal tumors has a short operation time, less blood loss, faster postoperative gastrointestinal function recovery, shorter hospitalization time, and no major complications. It is a more ideal and minimally invasive surgery.
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Objective To analyze the clinicopathological features of gastric stromal tumor with primary gastrointestinal carcinoma.Methods 469 cases of gastrointestinal stromal tumor (GIST) from January 2011 to December 2014 admitted to PLA General Hospital were retrospectively analyzed.Gastric stromal tumor patients with primary gastrointestinal carcinoma were screened.The concomitant gastrointestinal cancer site,stromal tumor size,mitotic activity,immunohistochemistry were also detected.Results The gastric stromal tumor with primary gastrointestinal carcinoma accounted for 14.7 ％ (69/469) of all the GIST,in which the small gastric stromal tumor accounted for 65.2 ％ (45/69) of the total and 9.59 ％ (45/469) of all the GIST.The diameter of all tumors was ＜ 5 cm,and the mitotic was ＜ 5/50 HPF.The positive rates of CD117,CD34,DOG-1 were 92.8 ％ (64/69),92.8 ％ (64/69),94.1％ (65/69).The Fletcher was classified as low-risk and extreme low-risk.Conclusions Gastric stromal tumor with primary gastrointestinal carcinoma has no specific clinical features and pathological immunohistochemical markers.Its malgnant degree is lower than GIST.Its prognosis is associated with primary gastrointestinal cancer staging.
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Objectives To analyze the clinical and pathological characteristics of gastric submucosal tumors (GSMTs), and evaluate the safety and efficacy of endoscopic treatment for GSMTs. Methods 61 patients with GSMTs were selected from June 2014 to September 2012 by endoscopy and ultrasonography;they were all treated by endoscopic therapy; pathological examination was took in all removed tumors, the tumors which could be the gastric stromal tumor were furtherly examined by molecular biology technique of immunohistochemistry. Result In 61 cas-es, 39 cases are female patients, accounting for 63.93%;the tumors located at the stomach fund accounted for 52.46%(32/61), at the gastric corpus for 21.31%(13/61), at the gastric antrum for 11.48 %(7/61), at cardia for 14.75%(9/61); 10 cases were treated by Endoscopic submucosal dissection, 21 by endoscopic submucosal excavation, 27 by Endoscopic full-thickness resection, 3 by Submucosal tunnelling endoscopic resection; in all 61 cases, 2 were changed to laparoscopic treatment because one tumor was too big and broke the Serous and another was located at mucus Lake of gastric fund, 1 occurred postoperative bleeding and was treated by laparoscopy successfully, 1 oc-curred postoperative perforation and was treated by endoscopy successfully; after pathological and immunohisto-chemical analysis, 34 tumors were identified as gastric stromal tumor and all of them in risk classification were at very low risk, 11 were leiomyoma, 5 were lipoma, 3 were heterotopic pancreas, 5 were calcifying fibrous pseudotu-mor, 2 were inflammatory fibroid polyps, and 1 was angiomatous proliferation; gastric stromal tumor at gastric fundus account for 73.53 % (25/34), at gastric corpus for 11.76 % (4/34), at gastric antrum for 5.88 % (2/34) and at cardia for 8.82 %(3/34). Conclusion Most GSMTs are found in female and commonly lack of specific clinical symptoms;GMSTs are commonly located at gastric fund and most of them are gastric stromal tumors, vast majority of gastric stromal tumors in the risk classification are at very low risk;the endoscopic resection is a mini-invasive, safe and ef-fective treatment for GSMTs.
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Objective To explore the long-term outcomes of endoscopic submucosal dissection (ESD) of gastric GISTs.Methods Data of 25 patients with gastric stromal tumors,who underwent ESD,were reviewed in terms of clinical characteristics,histopathologic results,complications and long-term outcomes.Results Twenty-five patients underwent one-time complete removal of lesion, with a average tumor size of 3.0 cm (range,0.6 to 7.6 cm).The average time of operation was 65 minutes (range,15 to 154 minutes).one case was observed with intraoperative hemor-rhage of 200 mL blood,which was successfully managed by hemostatic forceps.Perforation with incidence rate of 16%occurred in 4 cases and was closed well with clips.Mucosal mechanical laceration of esophagus occurred in 1 case when the big tumor was taken out.The average length of hospi-talization was 7.3 days (range,4 to 21 days).A follow-up for 30 months (range,13 to 54 months) showed no tumor recurrence or metastasis. Conclusion ESD is an effective and safe endoscopic procedure to remove gastric GISTs for long-term outcomes in patients with no metastasis.
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Objective To compare the efficacy and safety of endoscopy and laprotomy for gastric stromal tumor,and to evaluate the clinical value of endoscopy.Methods A retrospective analysis was made based on the clinical data of 142 patients with gastric stromal tumor(diameter＜3 cm with clear boundary),with 83 patients who underwent endoscopic resection assigned to the endoscopy group,and 59 patients who underwent laprotomic resection to the operation group.The clinical and pathological data in both groups were analysed and the safety,perioperative situation and prognosis of two groups were compared.Results Compared with the laprotomy group,the endoscopy group required the same time,[(88.25±12.18) min VS (90.15±10.25) min,P=0.367],yielded to less intraoperative blood loss[(42.15±22.13) ml VS (140.55±35.66) ml,P＜0.01],early postoperative feeding[(2.30± 1.20) d VS (5.40± 1.28) d,P＜0.01],and shorter postoperative hospital stay [(5.43± 1.78) d VS (9.42± 1.65) d,P＜0.01].Follow-up was performed in two groups for 5-55 months (median,30 months),with no recurrence or metastasis.Conclusion Compared with surgery,endoscopic therapy is safe and effective for the gastric stromal tumor,whose diameter is less than 3 cm with clear boundary.
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MicroRNAs (miRNAs) play important roles in carcinogenesis, but the global miRNA expression profile in gastric stromal tumor tissues remains unclear. This study was to examine the miRNA expression profile in gastric stromal tumor tissues and explore the function of dysregulated miRNAs by performing gene ontology (GO) and pathway enrichment analysis. Total RNA was extracted and purified from 3 pairs of frozen gastric stromal tumor tissues and the adjacent non-tumor tissues by using mirVana™ miRNA isolation kit. The miRNA expression was analyzed with Affymetrix microarrays (version 4.0) containing 2578 human mature microRNA probes. The dysregulated microRNAs were validated by quantitative RT-PCR in 30 pairs of gastric stromal tumor tissues. The target gene of the dysregulated microRNAs was predicted by miRanda, TargetScan and PicTar. GO and pathway enrichment analysis was conducted to examine the potential function of miR-3178 and miR-193a-5p. The results showed that there were 12 differently expressed microRNAs in gastric stromal tumor tissues, among which 10 miRNAs were down-regulated, and 2 were up-regulated (P<0.05). The validation results by RT-PCR were in accordance with those by microRNA microarry. GO analysis found that the target genes of miR-3178 were involved in 5 GO terms and those of miR-193a-5p in 7 GO terms in level 2. Pathway enrichment analysis suggested that miR-3178 and miR-193a-5p were related to 57 and 122 signaling pathways, respectively. It was concluded that gastric stromal tumor displays a unique miRNA signature. This specific expression may become a new diagnostic and prognostic biomarker for gastric stromal tumor. miR-3178 and miR-193a-5p function as suppressive microRNAs, and they may also become diagnosis and treatment targets for gastric stromal tumor.
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Aged , Female , Humans , Male , Middle Aged , Gastrointestinal Stromal Tumors , Genetics , General Surgery , Gene Expression Profiling , MicroRNAs , Genetics , Stomach Neoplasms , Genetics , General SurgeryABSTRACT
Objective To explore the clinical effects of laparoscopic combined with gastroscopic surgery for the gastric stromal tumors (GSTs) from the muscularis propria.Methods The clinical data of 25 patients with GSTs from the muscularis propria who were admitted to the Qianfoshan Hospital Affiliated to Shandong University between January 2011 and January 2014 were retrospectively analyzed.Patients received the general anaesthesia by endotracheal intubation.The pneumoperitoneum was done by an arc incision of 0.5 cm above margin of the umbilical cord and then laparoscopy was placed for exposing and gastroscopy was placed for confirming the location of the tumor.A laparoscope was placed in the cavity via the trocar at the navel,and the other two trocars penetrated both the abdominal and stomach walls.With gastroscopic monitoring,the operation was carried out in the gastric lumen using laparoscopic instruments and the tumor was resected.The tumor tissue was removed orally using a gastroscopic basket,and puncture holes and perforations were sutured using titanium clips.The proton pump inhibitor and antibiotics were used as the conventional therapy for 3 days,while adjuvant therapy with a usage of imatinib was applied to patients who were confirmed with the high-risk GSTs by pathological examination after tumors resection,and the other patients did not receive adjuvant therapy.Gastroscopic reexamination was done every 3 months within postoperative 1 year and then every 6 months after 1 year.Abdominal CT reexamination was done every 6 months within postoperative 1 year and then every 1 year after 1 year.The followup was done till December 2014.Results All the 25 patients received successfully modified laparoscopic combined with gastroscopic surgery without conversion to open surgery and postoperative complication.The operation time,volume of intraoperative blood loss,diameter of tumor,duration of postoperative abdominal pain and duration of hospital stay were (79 ± 4) minutes,(28 ± 3) mL,(2.6 ± 0.3) cm,(2.8 ± 0.3) days and (6.3 ± 0.3) days,respectively.GSTs were confirmed by postoperative pathological examination.The mitotic count was (3.3 ± 0.3) /50 HPF and reached R0 resection.Extremely low risk was detected in 3 patients,low risk in 19 patients,intermediate risk in 3 patients and no high risk was detected.Two of 3 patients with intermediate risk took the medicines following instructions without the adverse drug reaction,and 1 of 3 patients refused to take the medicines due to low income.All the patients were followed up for 12-36 months without the recurrence or metastasis of tumors.Conclusion Modified laparoscopic combined with gastroscopic surgery is feasible and effective for the treatment of gastric stromal tumors (GSTs) from the muscularis propria.
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Heterotopic pancreas is usually defined as a presence of pancreatic tissue without any anatomical or vascular continuity,and is one of the congenital and rare diseases.The clinical manifestations are easily confused with other gastrointestinal diseases,and conventional endoscopic examination cannot provide a clear preoperative diagnosis,therefore heterotopic pancreas is often misdiagnosed.It is very important to distinguish heterotopic pancreas and other digestive diseases.In this article,the clinical characteristics,differential diagnosis and treatment method of one patient with heterotopic pancreas who was admitted to the Affiliated Hospital of Chengde Medical College in March 2014 were analyzed.
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Objective To observe the efficacy and safety of endoscopic ultrasonography submucosal resection for treatment of gastric muscularis propria mesenchymal tumor.Methods Endoscopic ultrasonography preliminary diagnosis of 19 cases were diagnosed stromal tumors originating from gastric muscularis propria layer,the endoscopic ultrasonography diagnosis the source,echo,size,blood supply,etc.than treated by endoscopic submucosal excavation.To observe the therapeutic effect and complications.Results Eighteen patients were the full excavation,1 patient was failed.Intraoperative perforation was seen in 2 cases,the wound was healed by the titanium clamp.A small amount of bleeding happened in operation and bleeding was stopped by hot biopsy forceps or argon coagulation.No delayed bleeding happened.Conclusion Submucosal resection for gastric muscularis propria mesenchymal tumors is safe and effective,endoscopic ultrasonography has important value in the strict assessment.