title: Long-term outcomes of endoscopic submucosal dissection versus laparoscopic resection for gastric stromal tumors less than 2 cm.
abstract: OBJECTIVE
  Laparoscopic resection (LAP) and endoscopic submucosal dissection (ESD) of small gastrointestinal stromal tumors (GISTs) have been reported by large amount of literature. However, the management of small GISTs remains controversial. This study evaluated the efficacy of ESD and LAP for small gastric GISTs and provided long-term outcomes of the two methods.
  
  
  METHODS
  A total of 126 patients who underwent ESD or LAP for small gastric GISTs between 2009 and 2016 were retrospectively collected from medical records in our hospital, and we made telephone follow-up about recurrence rate. The parameters measured for each procedure type include clinicopathological characteristics, recurrence rate, and surgical outcomes.
  
  
  RESULTS
  Among the 126 patients, 75 (59.52%) received ESD, and 51(40.48%) received LAP. The clinicopathological characteristics of the patients were well balanced. There was also no significant difference in follow-up time (3.34 ± 1.53 years in ESD group and 3.41 ± 1.37 years in LAP group, P = 0.19). However, we observed significant difference about operating time, estimated blood loss, and hospital stay between ESD group and LAP group (63.59 ± 34.41 min vs 79.12 ± 43.47 min, P = 0.04; 8.53 ± 15.89 mL vs 17.16 ± 18.90 mL, P = 0.01; 6.60 ± 2.70 days vs 10.37 ± 3.50 days, P < 0.001, respectively). The recurrence rate of ESD and LAP group was 2.67% and 1.96%, respectively, P = 0.41. Kaplan-Meier curves for disease-free survival also showed no statistically significant difference (P = 0.72).
  
  
  CONCLUSIONS
  Endoscopic submucosal dissection is a preferable technique for resection of small gastric stromal tumors in the long-term outcomes compared with LAP. However, long-term randomized controlled trials are further needed.
authors.affiliation: Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Southern Medical University, Guangzhou, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Meng
authors.affiliation: Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Southern Medical University, Guangzhou, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.affiliation: Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Southern Medical University, Guangzhou, China.
authors.forename: Lu
authors.initials: L
authors.lastname: Han
authors.affiliation: Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Southern Medical University, Guangzhou, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Southern Medical University, Guangzhou, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Gong
authors.affiliation: Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Southern Medical University, Guangzhou, China.
authors.forename: Jianqun
authors.initials: J
authors.lastname: Cai
authors.affiliation: Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Southern Medical University, Guangzhou, China.
authors.forename: Aimin
authors.initials: A
authors.lastname: Li
authors.affiliation: Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Southern Medical University, Guangzhou, China.
authors.forename: Qun
authors.initials: Q
authors.lastname: Yan
authors.affiliation: Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Southern Medical University, Guangzhou, China.
authors.forename: Qiuhua
authors.initials: Q
authors.lastname: Lai
authors.affiliation: Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: Jiang
authors.initials: J
authors.lastname: Yu
authors.affiliation: Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Southern Medical University, Guangzhou, China.
authors.forename: Lan
authors.initials: L
authors.lastname: Bai
authors.affiliation: Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Southern Medical University, Guangzhou, China.
authors.forename: Side
authors.initials: S
authors.lastname: Liu
authors.affiliation: Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Southern Medical University, Guangzhou, China.
authors.forename: Yue
authors.initials: Y
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D013505:Digestive System Surgical Procedures / Q000379:methods*; D000069916:Endoscopic Mucosal Resection / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D046152:Gastrointestinal Stromal Tumors / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: endoscopic submucosal dissection; laparoscopic resection; small gastrointestinal stromal tumors