Endoscopic full-thickness resection vs surgical resection for gastric stromal tumors: Efficacy and safety using propensity score matching

BACKGROUND Endoscopic full-thickness resection (EFTR) is increasingly used for treating gastrointestinal stromal tumors (GISTs) in the stomach. AIM To compare the efficacy, tolerability, and clinical outcomes of EFTR vs surgical resection (SR) for gastric GISTs. METHODS We collected clinical data from patients diagnosed with GISTs who underwent either EFTR or SR at our hospital from October 2011 to July 2024. Patients were matched in a 1:1 ratio based on baseline characteristics and tumor clinical-pathological features using propensity score matching. We analyzed perioperative outcomes and follow-up data. The primary outcome measure was progression-free survival (PFS). RESULTS Out of 912 patients, 573 met the inclusion criteria. After matching, each group included 95 patients. The EFTR group demonstrated statistically significant advantages over the SR group in average operative time (P < 0.001), length of hospital stay (P < 0.001), time to resume liquid diet (P < 0.001), incidence of adverse events (P = 0.031), and hospitalization costs (P < 0.001). The en bloc resection rate was significantly different, with SR group at 100% and EFTR group at 93.7% (P = 0.038). The median follow-up was 2451.50 days. Recurrence occurred in 3 patients in the EFTR group and 4 patients in the SR group, with no statistically significant difference (P = 1.000). Factors associated with PFS included age, tumor size, high-risk category in the modified National Institutes of Health (NIH) risk score, and resection status. Resection status was identified as an independent prognostic factor for PFS (P = 0.0173, hazard ratios = 0.0179, 95%CI: 0.000655-0.491). Notably, there was no statistically significant difference in PFS between the two groups. CONCLUSION This study is a non-inferiority design. The EFTR group significantly outperformed the SR group in terms of operative time, length of hospital stay, time to resume a liquid diet, incidence of adverse events, and hospitalization costs, demonstrating its higher economic efficiency and better tolerability. Additionally, although the en bloc resection rate was lower in the EFTR group compared to the SR group, there were no significant differences in tumor recurrence rates and progression-free survival between the two groups. This study found no statistical difference in the primary endpoint of postoperative recurrence rates between the two groups. However, due to sample size limitations, this result requires further validation in larger-scale studies. The current results should be viewed as exploratory evidence.