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15.04.2023 | Original Article

Risk factors of perforation in gastric stromal tumors during endoscopic resection: a retrospective case–control study

verfasst von: Muhan Ni, Dehua Tang, Wei Ren, Rui Meng, Jinping Yang, Peng Yan, Xiwei Ding, Guifang Xu, Ying Lv, Min Chen, Hua Yang, Lei Wang

Erschienen in: Gastric Cancer | Ausgabe 4/2023

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Abstract

Background and aims

Perforation is a common complication during endoscopic resection (ER) of gastric gastrointestinal stromal tumors (gGISTs) associated with secondary infections, sepsis, hospitalization time and cost. However, the risk factors of perforation remain controversial. This study aimed to investigate the risk factors for perforation during ER of gGISTs.

Methods

This retrospective case–control study included consecutive patients with gGISTs who underwent ER between June 2009 and November 2021 at the Nanjing Drum Tower Hospital. Univariate and multivariate analyses were performed to investigate the risk factors for perforation. Sensitivity analyses with propensity scoring (PS) were performed to evaluate the stability of the independent effects.

Results

In total, 422 patients with gGISTs were included. The following factors were associated with perforation during ER: in the non-intraluminal growth patterns (all confounders adjusted odds ratio [aOR]: 5.39, 95% CI 2.99–9.72, P < 0.001), in the gastric fundus (aOR 2.25, 95% CI 1.40–3.60, P = 0.007), sized ≥ 2 cm (aOR 1.70, 95% CI 1.04–2.77, P = 0.035), in the lesser curvature (aOR 0.12, 95% CI 0.05–0.27, P < 0.001), and in the gastric cardia (aOR 0.13, 95% CI 0.04–0.50, P = 0.003). The PS analysis confirmed the stable independent effects of these identified risk factors.

Conclusions

ERs of gGISTs in non-intraluminal growth patterns, in the gastric fundus, and with larger tumor size were independent risk factors for perforation. While tumors in the lesser curvature or gastric cardia were independent protective factor for perforation.

Nur mit Berechtigung zugänglich

Miettinen M, El-Rifai W, HLS L, Lasota J. Evaluation of malignancy and prognosis of gastrointestinal stromal tumors: a review. Hum Pathol. 2002;33:478–83.PubMedCrossRef

Kawanowa K, Sakuma Y, Sakurai S, Hishima T, Iwasaki Y, Saito K, et al. High incidence of microscopic gastrointestinal stromal tumors in the stomach. Hum Pathol. 2006;37(12):1527–35.PubMedCrossRef

Demetri GD, von Mehren M, Antonescu CR, DeMatteo RP, Ganjoo KN, Maki RG, et al. NCCN task force report: update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Canc Netw. 2010. https://doi.org/10.6004/jnccn.2010.0116.CrossRefPubMedPubMedCentral

von Mehren M, Randall RL, Benjamin RS, Boles S, Bui MM, Ganjoo KN, et al. Soft tissue sarcoma, version 2.2018, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2018;16(5):536–63.CrossRef

Joo MK, Park JJ, Kim H, Koh JS, Lee BJ, Chun HJ, et al. Endoscopic versus surgical resection of GI stromal tumors in the upper GI tract. Gastrointest Endosc. 2016;83(2):318–26.PubMedCrossRef

Meng Y, Li W, Han L, Zhang Q, Gong W, Cai J, et al. Long-term outcomes of endoscopic submucosal dissection versus laparoscopic resection for gastric stromal tumors less than 2 cm. J Gastroenterol Hepatol. 2017;32(10):1693–7.PubMedCrossRef

Kim GH, Choi KD, Gong CS, Lee IS, Park YS, Han M, et al. Comparison of the treatment outcomes of endoscopic and surgical resection of GI stromal tumors in the stomach: a propensity score-matched case-control study. Gastrointest Endosc. 2020;91(3):527–36.PubMedCrossRef

Dong X, Chen W, Cui Z, Chen T, Liu X, Chen D, et al. Laparoscopic resection is better than endoscopic dissection for gastric gastrointestinal stromal tumor between 2 and 5 cm in size: a case-matched study in a gastrointestinal center. Surg Endosc. 2020;34(11):5098–106.PubMedCrossRef

Zhu H, Zhao S, Jiao R, Zhou J, Zhang C, Miao L. Comparison of endoscopic versus laparoscopic resection for gastric gastrointestinal stromal tumors: a preliminary meta-analysis. J Gastroenterol Hepatol. 2020;35(11):1858–68.PubMedCrossRef

10.

Liu Z, Zeng Z, Ouyang S, Zhang Z, Sun J, Wang X, et al. Comparison among endoscopic, laparoscopic, and open resection for relatively small gastric gastrointestinal stromal tumors (<5 cm): a Bayesian network meta-analysis. Front Oncol. 2021;11: 672364.PubMedPubMedCentralCrossRef

11.

Casali PG, Abecassis N, Aro HT, Bauer S, Biagini R, Bielack S, et al. Soft tissue and visceral sarcomas: ESMO-EURACAN clinical practice guidelines for diagnosis treatment and follow-up. Ann Oncol. 2018;29:iV51-iv67.PubMedCrossRef

12.

Ye LP, Zhang Y, Mao XL, Zhu LH, Zhou X, Chen JY. Submucosal tunneling endoscopic resection for small upper gastrointestinal subepithelial tumors originating from the muscularis propria layer. Surg Endosc. 2014;28(2):524–30.PubMedCrossRef

13.

Wang L, Ren W, Fan CQ, Li YH, Zhang X, Yu J, et al. Full-thickness endoscopic resection of nonintracavitary gastric stromal tumors: a novel approach. Surg Endosc. 2011;25(2):641–7.PubMedCrossRef

14.

Su W, Wang M, Zhang D, Zhu Y, Lv M, Zhu L, et al. Predictors of the difficulty for endoscopic resection of gastric gastrointestinal stromal tumor and follow-up data. J Gastroenterol Hepatol. 2022;37(1):48–55.PubMedCrossRef

15.

Yu C, Liao G, Fan C, Yu J, Nie X, Yang S, et al. Long-term outcomes of endoscopic resection of gastric GISTs. Surg Endosc. 2017;31(11):4799–804.PubMedCrossRef

16.

Huang LY, Cui J, Liu YX, Wu CR, Yi DL. Endoscopic therapy for gastric stromal tumors originating from the muscularis propria. World J Gastroenterol. 2012;18(26):3465–71.PubMedPubMedCentralCrossRef

17.

Chen Q, Yu M, Lei Y, Zhong C, Liu Z, Zhou X, et al. Efficacy and safety of endoscopic submucosal dissection for large gastric stromal tumors. Clin Res Hepatol Gastroenterol. 2020;44(1):90–100.PubMedCrossRef

18.

Shichijo S, Uedo N, Yanagimoto Y, Yamamoto K, Kono M, Fukuda H, et al. Endoscopic full-thickness resection of gastric gastrointestinal stromal tumor: a Japanese case series. Ann Gastroenterol. 2019;32(6):593–9.PubMedPubMedCentral

19.

Ye LP, Zhang Y, Luo DH, Mao XL, Zheng HH, Zhou XB, et al. Safety of endoscopic resection for upper gastrointestinal Subepithelial tumors originating from the muscularis Propria layer: an analysis of 733 tumors. Am J Gastroenterol. 2016;111(6):788–96.PubMedCrossRef

20.

Chen T, Zhou PH, Chu Y, Zhang YQ, Chen WF, Ji Y, et al. Long-term outcomes of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors. Ann Surg. 2017;265(2):363–9.PubMedCrossRef

21.

Zhang Y, Ye LP, Zhou XB, Mao XL, Zhu LH, He BL, et al. Safety and efficacy of endoscopic excavation for gastric subepithelial tumors originating from the muscularis propria layer: results from a large study in China. J Clin Gastroenterol. 2013;47(8):689–94.PubMedCrossRef

22.

Bialek A, Wiechowska-Kozlowska A, Pertkiewicz J, Polkowski M, Milkiewicz P, Karpinska K, et al. Endoscopic submucosal dissection for treatment of gastric subepithelial tumors (with video). Gastrointest Endosc. 2012;75(2):276–86.PubMedCrossRef

23.

Nagtegaal ID, Odze RD, Klimstra D, Paradis V, Rugge M, Schirmacher P, et al. The 2019 WHO classification of tumours of the digestive system. Histopathology. 2020;76(2):182–8.PubMedCrossRef

24.

Yang J, Ni M, Jiang J, Ren X, Zhu T, Cao S, et al. Comparison of endoscopic full-thickness resection and cap-assisted endoscopic full-thickness resection in the treatment of small (</=1.5 cm) gastric GI stromal tumors. Gastrointest Endosc. 2021. https://doi.org/10.1016/j.gie.2021.10.026.CrossRefPubMed

25.

An W, Sun PB, Gao J, Jiang F, Liu F, Chen J, et al. Endoscopic submucosal dissection for gastric gastrointestinal stromal tumors: a retrospective cohort study. Surg Endosc. 2017;31(11):4522–31.PubMedCrossRef

26.

Liu F, Zhang S, Ren W, Yang T, Lv Y, Ling T, et al. The fourth space surgery: endoscopic subserosal dissection for upper gastrointestinal subepithelial tumors originating from the muscularis propria layer. Surg Endosc. 2018;32(5):2575–82.PubMedCrossRef

27.

Zhou PH, Yao LQ, Qin XY, Cai MY, Xu MD, Zhong YS, et al. Endoscopic full-thickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria. Surg Endosc. 2011;25(9):2926–31.PubMedCrossRef

28.

Shi Q, Zhong YS, Yao LQ, Zhou PH, Xu MD, Wang P. Endoscopic submucosal dissection for treatment of esophageal submucosal tumors originating from the muscularis propria layer. Gastrointest Endosc. 2011;74(6):1194–200.PubMedCrossRef

29.

Kim M, Jeon SW, Cho KB, Park KS, Kim ES, Park CK, et al. Predictive risk factors of perforation in gastric endoscopic submucosal dissection for early gastric cancer: a large, multicenter study. Surg Endosc. 2013;27(4):1372–8.PubMedCrossRef

30.

Ohta T, Ishihara R, Uedo N, Takeuchi Y, Nagai K, Matsui F, et al. Factors predicting perforation during endoscopic submucosal dissection for gastric cancer. Gastrointest Endosc. 2012;75(6):1159–65.PubMedCrossRef

31.

Cai MY, Zhu BQ, Xu MD, Qin WZ, Zhang YQ, Chen WF, et al. Submucosal tunnel endoscopic resection for extraluminal tumors: a novel endoscopic method for en bloc resection of predominant extraluminal growing subepithelial tumors or extra-gastrointestinal tumors (with videos). Gastrointest Endosc. 2018;88(1):160–7.PubMedCrossRef

32.

Joensuu H. Risk stratification of patients diagnosed with gastrointestinal stromal tumor. Hum Pathol. 2008;39(10):1411–9.PubMedCrossRef

33.

Bronswijk M, Vanella G, van Malenstein H, Laleman W, Jaekers J, Topal B, et al. Laparoscopic versus EUS-guided gastroenterostomy for gastric outlet obstruction: an international multicenter propensity score-matched comparison (with video). Gastrointest Endosc. 2021;94(3):526–33.PubMedCrossRef

34.

Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.PubMedCrossRef

35.

Koo DH, Ryu MH, Kim KM, Yang HK, Sawaki A, Hirota S, et al. Asian consensus guidelines for the diagnosis and management of gastrointestinal stromal tumor. Cancer Res Treat. 2016;48(4):1155–66.PubMedPubMedCentralCrossRef

36.

Regal RR, Hook EB. Marginal versus conditional versus “structural source” models: a rationale for an alternative to log-linear methods for capture-recapture estimates. Stat Med. 1998;17(1):69–74.PubMedCrossRef

37.

Kurth T, Walker AM, Glynn RJ, Chan KA, Gaziano JM, Berger K, et al. Results of multivariable logistic regression, propensity matching, propensity adjustment, and propensity-based weighting under conditions of nonuniform effect. Am J Epidemiol. 2006;163(3):262–70.PubMedCrossRef

38.

Rajan E, Song WK, LM. Endoscopic full thickness resection. Gastroenterology. 2018;154(7):1925–37.PubMedCrossRef

39.

Li J, Ye Y, Wang J, Zhang B, Qin S, Shi Y, et al. Chinese consensus guidelines for diagnosis and management of gastrointestinal stromal tumor. Chin J Cancer Res. 2017;29(4):281–93.PubMedPubMedCentralCrossRef

40.

Hohenberger P, Ronellenfitsch U, Oladeji O, Pink D, Strobel P, Wardelmann E, et al. Pattern of recurrence in patients with ruptured primary gastrointestinal stromal tumour. Br J Surg. 2010;97(12):1854–9.PubMedCrossRef

41.

Yanagimoto Y, Takahashi T, Muguruma K, Toyokawa T, Kusanagi H, Omori T, et al. Re-appraisal of risk classifications for primary gastrointestinal stromal tumors (GISTs) after complete resection: indications for adjuvant therapy. Gastric Cancer. 2015;18(2):426–33.PubMedCrossRef

42.

Joo MK, Park JJ, Lee YH, Lee BJ, Kim SM, Kim WS, et al. Clinical Efficacy and safety of endoscopic treatment of gastrointestinal stromal tumors in the stomach. Gut Liver. 2023. https://doi.org/10.5009/gnl210454.CrossRefPubMedPubMedCentral

43.

Huang L, Jia YX, Lyu B, Meng LN, Jin HF. Effects of endoscopic submucosal excavation with non-submucosal injection on stromal tumors in stomach. Front Oncol. 2022;12: 792445.PubMedPubMedCentralCrossRef

44.

Cho J, Han J, Choi M, Song J, Yang M, Lee Y. Correlation between endoscopic resection outcomes and endosonographic findings in gastric tumors with muscularis propria origin. Medicine (Baltimore). 2022;101(32): e29947.PubMedCrossRef

45.

He Z, Sun C, Wang J, Zheng Z, Yu Q, Wang T, et al. Efficacy and safety of endoscopic submucosal dissection in treating gastric subepithelial tumors originating in the muscularis propria layer: a single-center study of 144 cases. Scand J Gastroenterol. 2013;48(12):1466–73.PubMedCrossRef

46.

Meng FS, Zhang ZH, Shan GD, Chen YP, Ji F. Endoscopic submucosal dissection for the treatment of large gastric submucosal tumors originating from the muscularis propria layer: a single center study. Z Gastroenterol. 2015;53(7):655–9.PubMedCrossRef

47.

Yoon JY, Shim CN, Chung SH, Park W, Chung H, Lee H, et al. Impact of tumor location on clinical outcomes of gastric endoscopic submucosal dissection. World J Gastroenterol. 2014;20(26):8631–7.PubMedPubMedCentralCrossRef

48.

Yoo JH, Shin SJ, Lee KM, Choi JM, Wi JO, Kim DH, et al. Risk factors for perforations associated with endoscopic submucosal dissection in gastric lesions: emphasis on perforation type. Surg Endosc. 2012;26(9):2456–64.PubMedCrossRef

49.

van Rutte PW, Naagen BJ, Spek M, Jakimowicz JJ, Nienhuijs SW. Gastric wall thickness in sleeve gastrectomy patients: thickness variation of the gastric wall. Surg Technol Int. 2015;27:123–8.PubMed

50.

Zhao J, Liao D, Chen P, Kunwald P, Gregersen H. Stomach stress and strain depend on location, direction and the layered structure. J Biomech. 2008;41(16):3441–7.PubMedCrossRef

51.

Suzuki H, Oda I, Sekiguchi M, Abe S, Nonaka S, Yoshinaga S, et al. Management and associated factors of delayed perforation after gastric endoscopic submucosal dissection. World J Gastroenterol. 2015;21(44):12635–43.PubMedPubMedCentralCrossRef

52.

Ojima T, Takifuji K, Nakamura M, Iwahashi M, Nakamori M, Katsuda M, et al. Complications of endoscopic submucosal dissection for gastric noninvasive neoplasia: an analysis of 647 lesions. Surg Laparosc Endosc Percutan Tech. 2014;24(4):370–4.PubMedCrossRef

53.

Jeong ID, Jung SW, Bang SJ, Shin JW, Park NH, Kim DH. Endoscopic enucleation for gastric subepithelial tumors originating in the muscularis propria layer. Surg Endosc. 2011;25(2):468–74.PubMedCrossRef

54.

Lu J, Jiao T, Li Y, Zheng M, Lu X. Facilitating retroflexed endoscopic full-thickness resection through loop-mediated or rope-mediated countertraction (with videos). Gastrointest Endosc. 2016;83(1):223–8.PubMedCrossRef

Titel: Risk factors of perforation in gastric stromal tumors during endoscopic resection: a retrospective case–control study
verfasst von: Muhan Ni
Dehua Tang
Wei Ren
Rui Meng
Jinping Yang
Peng Yan
Xiwei Ding
Guifang Xu
Ying Lv
Min Chen
Hua Yang
Lei Wang
Publikationsdatum: 15.04.2023
Verlag: Springer Nature Singapore
Erschienen in: Gastric Cancer / Ausgabe 4/2023
Print ISSN: 1436-3291
Elektronische ISSN: 1436-3305
DOI: https://doi.org/10.1007/s10120-023-01391-4

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