title: Comparison of endoscopic submucosal dissection and surgery for the treatment of gastric submucosal tumors originating from the muscularis propria layer: a single-center study (with video).
abstract: Endoscopic submucosal dissection (ESD) has been used for the treatment of gastric submucosal tumors (SMTs). This study aims to compare clinical outcomes of ESD versus laparoscopic wedge resection (LWR) for gastric SMTs.
  
  
  
  This is a retrospective cohort study. Patients with SMTs who underwent ESD or LWR were enrolled in this study at a university-affiliated hospital from January 2010 to October 2015. Preoperative endoscopic ultrasound and computed tomography were performed to determine origin of layer and growth pattern. Clinical outcomes including baseline demographics, tumor size, operation time, blood loss, hospital stay, cost, pathology and postoperative complications were compared.
  
  
  
  From January 2010 to October 2015, 68 patients with SMTs received ESD and 47 patients with SMTs received LWR. There was no difference in age, gender, body mass index, origin of layer and proportion with symptoms between ESD group and LWR group. However, tumor size was significantly larger in the LWR group (37.1 mm) than in the ESD group (25.8 mm, P = 0.041). For patients with tumors smaller than 20 mm, ESD was associated with shorter mean operation time (89.7 ± 23.5 vs 117.6 ± 23.7 min, P = 0.043), less blood loss (4.9 ± 1.7 vs 72.3 ± 23.3 ml, P < 0.001), shorter length of hospital stay (3.6 ± 1.9 vs 6.9 ± 3.7 days, P = 0.024) and lower cost (2471 ± 573 vs 4498 ± 1257 dollars, P = 0.031) when compared with LWR. For patients with tumors between 20 mm and 50 mm, ESD was associated with shorter mean operation time (99.3 ± 27.8 vs 125.2 ± 31.5 min, P = 0.039), less blood loss (10.1 ± 5.3 vs 87.6 ± 31.3 ml, P < 0.001), shorter length of hospital stay (4.0 ± 1.7 vs 7.3 ± 4.5 days, P = 0.027) and lower cost (2783 ± 601 vs 4798 ± 1343 dollars, P = 0.033) when compared with LWR. There were no significant differences in terms of rates of en bloc resection, complete resection and complication and histological diagnosis regardless of tumor size.
  
  
  
  ESD can achieve similar oncological outcomes when compared with surgery for treatment of gastric SMT smaller than 50 mm.
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road No. 79, Hangzhou, 310000, China.
authors.forename: Fan-Sheng
authors.initials: FS
authors.lastname: Meng
authors.affiliation: Department of Hematology, Linyi People's Hospital, Jiefang Road No. 27, Linyi, 276300, China.
authors.forename: Zhao-Hong
authors.initials: ZH
authors.lastname: Zhang
authors.affiliation: Department of Gastrointestinal Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road No. 79, Hangzhou, 310000, China.
authors.forename: Yan-Yun
authors.initials: YY
authors.lastname: Hong
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road No. 79, Hangzhou, 310000, China.
authors.forename: De-Jian
authors.initials: DJ
authors.lastname: Li
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road No. 79, Hangzhou, 310000, China.
authors.forename: Jie-Qiong
authors.initials: JQ
authors.lastname: Lin
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road No. 79, Hangzhou, 310000, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road No. 79, Hangzhou, 310000, China. jifeng1126@sina.com.
authors.forename: Feng
authors.initials: F
authors.lastname: Ji
mesh_terms: D015331:Cohort Studies; D000069916:Endoscopic Mucosal Resection / Q000379:methods; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery; D046152:Gastrointestinal Stromal Tumors / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000473:pathology*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
keywords: Endoscopic submucosal dissection; Gastrointestinal stromal tumor; Laparoscopic wedge resection; Submucosal tumor; Surgery