title: Safety analysis of laparoscopic endoscopic cooperative surgery versus endoscopic submucosal dissection for selected gastric gastrointestinal stromal tumors: a propensity score-matched study.
abstract: Laparoscopic endoscopic cooperative surgery (LECS) is a safe alternative to endoscopic submucosal dissection (ESD) for select gastric gastrointestinal stromal tumors (GISTs) that are <2 cm in size. To date, there have been no randomized studies comparing the feasibility of these two techniques. Therefore, we compared their feasibility and safety using the propensity score matching method in this study.
  
  
  
  This was a single-center, retrospective, propensity score-matched study of patients who underwent resection of selected gastric GISTs between 2004 and 2014. All patients underwent curative resection for pathologically diagnosed small gastric GISTs. The primary aim was to determine intraoperative complications and postoperative courses. To overcome selection biases, we performed a 1:1 match using five covariates, including age, gender, body mass index, Charlson comorbidity index, and tumor location, to generate propensity scores.
  
  
  
  In total, 32 patients treated with LECS and 102 patients treated with ESD were balanced into 30 pairs. The rate of intraoperative complications was significantly lower in the LECS group than in the ESD group (P = 0.029). LECS patients had less intraoperative bleeding than did ESD patients (15.0 ml [range 9.5-50.0 ml] vs. 43.5 ml [range 22.3-56.0 ml], P = 0.004). The two groups had similar postoperative courses. There was no difference in the reoperation rate between the two groups (P = 0.112). The ESD group had a shorter operating time than did the LECS group (41.5 min vs. 96.5 min, P < 0.001). However, during a follow-up of 57.9 (±28.9) months, the recurrence rate did not differ significantly between the two groups (0.0 vs. 6.7 %, respectively; P = 0.256).
  
  
  
  LECS for selected gastric GIST patients is feasible and is associated with a better intraoperative outcome and an equal postoperative course compared with the results of ESD.
authors: Department of General Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, China.
authors: A I
authors: AI
authors: Balde
authors: Department of General Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, China.
authors: Tao
authors: T
authors: Chen
authors: Department of General Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, China.
authors: Yanfeng
authors: Y
authors: Hu
authors: Department of General Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, China.
authors: J D
authors: JD
authors: Redondo N
authors: Department of General Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, China.
authors: Hao
authors: H
authors: Liu
authors: Department of Digestive Endoscopy, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong Province, China.
authors: Wei
authors: W
authors: Gong
authors: Department of General Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, China.
authors: Jiang
authors: J
authors: Yu
authors: Department of General Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, China. zhenli5168@126.com.
authors: Li
authors: L
authors: Zhen
authors: Department of General Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, China. gzliguoxin@163.com.
authors: Guoxin
authors: G
authors: Li
mesh_terms: D000328:Adult; D000069916:Endoscopic Mucosal Resection / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D011184:Postoperative Period; D057216:Propensity Score; D012086:Reoperation; D012189:Retrospective Studies; D012449:Safety; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
keywords: Endoscopic submucosal dissection; Gastric; Gastrointestinal stromal tumors; Laparoscopic endoscopic cooperative surgery; Propensity score matching