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Kim JY, Kim TJ, Lee DK, Min YW, Lee H, Min BH, Lee JH, An JY, Choi MG, Sohn TS, Bae JM, Kim HS, Ahn JH, Kim JJ. A preoperative risk prediction model for high malignancy potential gastrointestinal stromal tumors of the stomach. Surg Endosc 2021; 36:2129-2137. [PMID: 33999252 DOI: 10.1007/s00464-021-08501-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 04/03/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gastric gastrointestinal stromal tumors (GISTs) exhibit various degrees of aggression and malignant potential. However, no systematic preoperative evaluation strategy to predict the malignancy potential of gastric GISTs has yet been developed. This study aimed to develop a reliable and easy-to-use preoperative risk-scoring model for predicting high malignancy potential (HMP) gastric GISTs. METHODS The data of 542 patients with pathologically confirmed gastric GISTs who underwent resection were reviewed. Multivariate logistic regression analysis was used to identify significant predictors of HMP. The risk-scoring system (RSS) was based on the predictive factors for HMP, and its performance was validated using a split-sample approach. RESULTS A total of 239 of 542 (44.1%) surgically resected gastric GISTs had HMP. Multivariate analysis demonstrated that tumor size, location, and surface changes were independent risk factors for HMP. Based on the accordant regression coefficients, the presence of surface ulceration was assigned 1 point. Tumor sizes of 4-6 cm and > 6 cm were assigned 2 and 5 points, respectively. Two points were assigned to cardia or fundus locations. A score of 3 points was the optimal cut-off value for HMP prediction. HMP were found in 19.8% and 82.7% of the low and high-risk groups of the RSS, respectively. The area under the receiver-operating characteristic curve for predicting HMP was 0.81 (95% confidence interval (CI) 0.75-0.86). Discrimination was good after validation (0.75, 95% CI 0.69-0.81). CONCLUSION This simple RSS could be useful for predicting the malignancy potential of gastric GISTs and may aid preoperative clinical decision making to ensure optimal treatment.
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Affiliation(s)
- Jun Young Kim
- Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Tae Jun Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Dong Kyu Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Yang Won Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Hyuk Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Byung-Hoon Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Jun Haeng Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Ji Yeong An
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Gew Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Sung Sohn
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Moon Bae
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Seung Kim
- Statistics and Data Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joong Hyun Ahn
- Statistics and Data Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae J Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
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Di Maria Grimaldi S, Marano A, Pellegrino L, Geretto P, Palagi S, Borghi F. Robotic Wedge Resection for Unfavorably Located Gastric Gastrointestinal Stromal Tumors: Perioperative and Long-Term Oncological Outcomes. J Laparoendosc Adv Surg Tech A 2020; 31:772-778. [PMID: 33155875 DOI: 10.1089/lap.2020.0660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Background and Objectives: Robotic wedge resection for gastrointestinal stromal tumors (GISTs) located in the stomach offers remarkable advantages, especially for lesions in unfavorable places. Although promising, long-term oncological results associated with this surgical procedure are poorly represented in literature. We present our experience of robotic wedge resection with gastrotomy for challenging gastric GISTs, in terms of both surgical outcomes and long-term oncological results. Methods: From April 2014 to February 2020, all consecutive patients affected by unfavorably located gastric GISTs (based on the Privette/Al-Thani classification system) underwent robotic wedge resection. Clinicopathological, surgical, and long-term oncological results were retrospectively analyzed. Results: Seventeen patients underwent full-thickness gastric wedge resection with primary robot-sewn closure of the defect. In 64.7% of cases, the lesion was ≥5 cm in diameter. No conversion nor tumor rupture were recorded and complete R0 resection was achieved in all cases. Median hospital stay was 5 days (range 3-18). At a median follow-up of 46 months (range 7-67), the disease-free survival rate and the overall survival rate were 94.1% and 82.3%, respectively. Conclusions: Robotic wedge resection with gastrotomy and robotic-sewn suture is a safe and feasible procedure for GISTs located in unfavorable anatomic positions, without compromising oncological outcomes.
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Affiliation(s)
- Simone Di Maria Grimaldi
- General and Oncologic Surgery Unit, Department of Surgery, ASO Santa Croce e Carle, Cuneo, Italy
| | - Alessandra Marano
- General and Oncologic Surgery Unit, Department of Surgery, ASO Santa Croce e Carle, Cuneo, Italy
| | - Luca Pellegrino
- General and Oncologic Surgery Unit, Department of Surgery, ASO Santa Croce e Carle, Cuneo, Italy
| | - Paolo Geretto
- General and Oncologic Surgery Unit, Department of Surgery, ASO Santa Croce e Carle, Cuneo, Italy
| | - Silvia Palagi
- General and Oncologic Surgery Unit, Department of Surgery, ASO Santa Croce e Carle, Cuneo, Italy
| | - Felice Borghi
- General and Oncologic Surgery Unit, Department of Surgery, ASO Santa Croce e Carle, Cuneo, Italy
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Yang Z, Gao Y, Fan X, Zhao X, Zhu S, Guo M, Liu Z, Yang X, Han Y. A multivariate prediction model for high malignancy potential gastric GI stromal tumors before endoscopic resection. Gastrointest Endosc 2020; 91:813-822. [PMID: 31585126 DOI: 10.1016/j.gie.2019.09.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 09/21/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Endoscopic resection is becoming an option in the management of gastric GI stromal tumors (GISTs). Although no consensus has been reached, patients with high malignancy potential GISTs are generally considered to be surgical candidates. However, no systematic preoperative evaluation strategy has yet been developed. The current study was performed to develop a preoperative multivariate model to predict the malignant potential of gastric GISTs. METHODS This study consisted of 2 stages. First, a multivariate prediction model for gastric GISTs smaller than 5 cm was developed using a multivariate logistic regression analysis in a retrospective cohort. Next, the prediction model was validated further in a validation cohort of gastric GISTs. RESULTS In the developing stage, 275 patients were included. The multivariate analysis demonstrated that independent risk factors for high malignancy potential gastric GISTs smaller than 5 cm were tumor size ≥2 cm (according to cutoff value), an irregular tumor shape, and mucosal ulceration (P < .05). Based on accordant regression coefficients, 3 risk factors were weighted with point values: 1 point for mucosal ulceration, 2 points for an irregular tumor shape, and 3 points for tumor size ≥2 cm. In the validation stage, 186 patients were included. The area under the curve of the prediction model was .80 (95% confidence interval, .73-.85), which was significantly higher than that of tumor size alone (P = .034). CONCLUSIONS The independent risk factors for high malignancy potential gastric GISTs smaller than 5 cm were tumor size larger than 2 cm, an irregular tumor shape, and mucosal ulceration. These factors could be used to predict malignancy potential of gastric GISTs in a simple combination.
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Affiliation(s)
- Ze Yang
- Division 5, Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Yuan Gao
- Department of Gastroenterology, Ankang Central Hospital, Shaanxi, China
| | - Xiaotong Fan
- Division 5, Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Xin Zhao
- Division 5, Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Shaohua Zhu
- Division 5, Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Meng Guo
- Division 5, Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Zhiguo Liu
- Division 5, Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Xiaocui Yang
- Department of Gastroenterology, Ankang Central Hospital, Shaanxi, China
| | - Ying Han
- Division 5, Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China
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Rajravelu RK, Ginsberg GG. Management of gastric GI stromal tumors: getting the GIST of it. Gastrointest Endosc 2020; 91:823-825. [PMID: 32204815 DOI: 10.1016/j.gie.2019.11.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 11/23/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Ravy K Rajravelu
- Gastroenterology Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Gregory G Ginsberg
- Gastroenterology Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Supsamutchai C, Setthalikhit T, Wilasrusmee C, Ovartchaiyapong P, Jirasiritham J, Choikrua P, Hiranyatheb P. Wedge gastrectomy: Robot-assisted with a hand-sewn repair versus a laparoscopic linear stapler technique for gastric subepithelial tumors. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2020. [DOI: 10.1016/j.lers.2019.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Robotic Gastrotomy With Intracorporeal Suture for Patients With Gastric Gastrointestinal Stromal Tumors Located at Cardia and Subcardiac Region. Surg Laparosc Endosc Percutan Tech 2018; 28:e1-e7. [PMID: 29215507 PMCID: PMC5802256 DOI: 10.1097/sle.0000000000000498] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Few studies of robotic gastric gastrointestinal stromal tumors (GISTs) resection have been conducted. This study was aimed to evaluate the robotic gastrotomy with intracorporeal suture for patients with GISTs located at cardia and subcardiac region. MATERIALS AND METHODS From January 2014 to August 2016, 11 patients with GISTs located at cardia and subcardiac region underwent robotic gastrotomy with intracorporeal suture. Data of these patients were collected. RESULTS The mean operative time was 82.7 minutes and the mean blood loss was 30.0 mL. No complication was reported. The postoperative length of stay was 3.3 days. On postoperative day 14, inflammation recovered to preoperative level. On postoperative month 6, the nutritional status was similar to that before the surgery. After 25.5 months follow-up, all patients survived with no recurrence or metastasis. CONCLUSIONS Robotic gastrotomy with intracorporeal suture for patients with GISTs located at cardia and subcardiac region is safe and feasible.
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Abe N, Takeuchi H, Ohki A, Hashimoto Y, Mori T, Sugiyama M. Comparison between endoscopic and laparoscopic removal of gastric submucosal tumor. Dig Endosc 2018; 30 Suppl 1:7-16. [PMID: 29658656 DOI: 10.1111/den.13010] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/05/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM A retrospective study was conducted to compare two resection methods, namely, endoscopic resection (ER) procedures (endoscopic submucosal dissection [ESD], endoscopic muscularis dissection [EMD], and endoscopic full-thickness resection [EFTR]) and laparoscopic resections (LR) (laparoscopic endoscopic cooperative surgery [LECS] and laparoscopic wedge resection). METHODS Seventy-three patients who underwent ER (N = 33: ESD, N = 4; EMD, N = 15; EFTR, N = 14) or LR (N = 39: LECS, N = 16; wedge resection, N = 23) for gastric submucosal tumor (G-SMT) smaller than 50 mm were included in this study. Patient/tumor characteristics and intra/postoperative factors were compared between the ER and LR groups. RESULTS The ER group had a significantly higher percentage of intraluminal growing type of tumor (100% vs 41%) and smaller tumor size (23 vs 33 mm) than the LR group. The ER group had a significantly shorter operative time (93 vs 145 min) and less blood loss (13 vs 30 mL) than the LR group. In the ER group, three patients who had tumors located on the anterior wall of the stomach required laparoscopic closure after EFTR because of difficulty in endoscopic closure of the gastric-wall defect. Postoperative complication rates and duration of postoperative hospital stays did not differ between the two groups. CONCLUSIONS ER may be technically feasible, safe, less invasive, and oncologically appropriate options for selected patients with the intraluminal growing type of G-SMT smaller than 30 mm. EFTR may be more reasonable alternatives to LR in selected patients with a small G-SMT located on the lesser curvature side.
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Affiliation(s)
- Nobutsugu Abe
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Hirohisa Takeuchi
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Atsuko Ohki
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | | | - Toshiyuki Mori
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Masanori Sugiyama
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
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