Comparison of the treatment outcomes of endoscopic and surgical resection of GI stromal tumors in the stomach: a propensity score-matched case-control study

Background and Aims: We aimed to investigate the safety and efficacy of endoscopic resection (ER) compared with surgical resection (SR) of gastric GI stromal tumors (GISTs). Methods: This study included 51 and 403 patients who underwent ER and SR, respectively, for <= 5 cm GISTs in the stomach between June 2005 and August 2017. After propensity score matching (1:1) using age, sex, tumor size, mitotic count, and comorbidities, the oncologic outcomes were compared with 48 patients each from ER and SR groups. Results: The ER group had significantly shorter hospital stay (4.4 +/- 2.9 vs 6.6 +/- 3.6 days, P < .001) and procedure time (38.3 +/- 24.2 vs 66 +/- 33.3 min, P < .001). The R0 resection rate was 62.7% in the ER group and 98.5% in the SR group. In the ER group, macroperforation occurred in 6 patients (11.8%) with a tumor located in the fundus (4/6, 66.7%) or body (2/6, 33.3%). All cases of perforation were cured with conservative treatment. In the SR group, postoperative adverse events such as stricture and leakage occurred in 7 patients (1.7%) with a tumor located in the antrum (4/7, 57.1%) or cardia (3/7, 42.9%). After matching, the overall mean follow-up period was 47.9 +/- 37.8 months in the ER group and 41.3 +/- 22.6 months in the SR group. No recurrence or distant metastasis occurred in either group during the follow-up period. Conclusions: ER is an effective and safe therapeutic method that might be comparable with SR for treating small-sized (<= 5 cm) gastric GISTs. Selecting the resection method according to the tumor location seems appropriate.