Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 1/2020

01-01-2020 | Gastrointestinal Stromal Tumor

Microscopic positive tumor margin does not increase the rate of recurrence in endoscopic resected gastric mesenchymal tumors compared to negative tumor margin

Authors: Yan Zhu, Mei-Dong Xu, Chen Xu, Xiao-Cen Zhang, Shi-Yao Chen, Yun-Shi Zhong, Yi-Qun Zhang, Wei-Feng Chen, Tian-Yin Chen, Jia-Xin Xu, Li-Qing Yao, Quan-Lin Li, Ping-Hong Zhou

Published in: Surgical Endoscopy | Issue 1/2020

Login to get access

Abstract

Background

The endoscopic resection of gastrointestinal mesenchymal tumors (GIMTs) is widely accepted because of its minimal invasiveness. However, one major concern is the high rate of positive microscopic margins remaining following endoscopic resection, which was thought to be related to a higher risk of recurrence. This study aimed to determine whether positive margins affect the recurrence rate of gastric GIMTs and the factors associated with positive margins.

Methods

Patients with gastric GIMTs were recruited retrospectively from January 2008 to December 2013. Clinical and pathological features, endoscopic procedure information, and follow-up data were collected and analyzed.

Results

The study included 777 patients. All tumors were removed along with the pseudocapsule without macroscopic residual (ER0), and the median tumor size was 15.2 mm (range 3–100 mm). Pathological evaluation revealed 371(47.7%) GISTs. The rate of microscopic R1 resection rate was 47.0% (443/777). In a stepwise multivariate analysis, a significantly increased incidence of R1 resection was recorded for the GISTs (OR 11.13, 95% CI 3.00–41.37). In a subgroup analysis of GISTs, a univariate analysis revealed that EFTR achieved a higher rate of R0 resection (OR 0.56, 95% CI 0.31–1.00), but it was proven insignificant in a stepwise multivariate analysis. Local recurrence occurred in two patients (0.3%) during a mean follow-up time of 34.2 months. Differences in the recurrence rates between the R0 and R1 groups were statistically insignificant (P = 0.841).

Conclusions

R1 resection for gastric GIMTs is not related to a higher recurrence rate than R0 resection, and ER0 resection is sufficient for gastric GIMTs.
Literature
1.
Bucher P, Villiger P, Egger JF, Buhler LH, Morel P (2004) Management of gastrointestinal stromal tumors: from diagnosis to treatment. Swiss Med Wkly 134:145–153PubMed
2.
Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O’Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW (2002) Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol 33:459–465CrossRef
3.
Joo MK, Park JJ, Kim H, Koh JS, Lee BJ, Chun HJ, Lee SW, Jang YJ, Mok YJ, Bak YT (2016) Endoscopic versus surgical resection of GI stromal tumors in the upper GI tract. Gastrointest Endosc 83:318–326CrossRef
4.
Catena F, Di Battista M, Ansaloni L, Pantaleo M, Fusaroli P, Di Scioscio V, Santini D, Nannini M, Saponara M, Ponti G, Persiani R, Delrio P, Coccolini F, Di Saverio S, Biasco G, Lazzareschi D, Pinna A (2012) Microscopic margins of resection influence primary gastrointestinal stromal tumor survival. Onkologie 35:645–648PubMed
5.
Zhi X, Jiang B, Yu J, Roe OD, Qin J, Ni Q, Sun L, Xu M, Zhu J, Ma L (2016) Prognostic role of microscopically positive margins for primary gastrointestinal stromal tumors: a systematic review and meta-analysis. Sci Rep 6:21541CrossRef
6.
McCarter MD, Antonescu CR, Ballman KV, Maki RG, Pisters PW, Demetri GD, Blanke CD, von Mehren M, Brennan MF, McCall L, Ota DM, DeMatteo RP (2012) Microscopically positive margins for primary gastrointestinal stromal tumors: analysis of risk factors and tumor recurrence. J Am Coll Surg 215:53–59. (discussion 59–60)CrossRef
7.
Jain D, Desai A, Mahmood E, Singhal S (2017) Submucosal tunneling endoscopic resection of upper gastrointestinal tract tumors arising from muscularis propria. Ann Gastroenterol 30:262–272PubMedPubMedCentral
8.
Lu J, Jiao T, Zheng M, Lu X (2014) Endoscopic resection of submucosal tumors in muscularis propria: the choice between direct excavation and tunneling resection. Surg Endosc 28:3401–3407CrossRef
9.
Zhang Y, Ye LP, Mao XL (2015) Endoscopic treatments for small gastric subepithelial tumors originating from muscularis propria layer. World J Gastroenterol 21:9503–9511CrossRef
10.
Zhou PH, Shi Q, Zhong YS, Yao LQ (2013) New progress in endoscopic treatment of esophageal diseases. World J Gastroenterol 19:6962–6968CrossRef
11.
Sarker S, Gutierrez JP, Council L, Brazelton JD, Kyanam Kabir Baig KR, Monkemuller K (2014) Over-the-scope clip-assisted method for resection of full-thickness submucosal lesions of the gastrointestinal tract. Endoscopy 46:758–761CrossRef
12.
Zhou PH, Yao LQ, Qin XY, Cai MY, Xu MD, Zhong YS, Chen WF, Zhang YQ, Qin WZ, Hu JW, Liu JZ (2011) Endoscopic full-thickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria. Surg Endosc 25:2926–2931CrossRef
13.
Chen T, Zhou PH, Chu Y, Zhang YQ, Chen WF, Ji Y, Yao LQ, Xu MD (2017) Long-term outcomes of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors. Ann Surg 265:363–369CrossRef
14.
Huang H, Li C, Huang W, Hu T, Lin C, Uen Y, Hsiung C, Lu D (2007) A modification of NIH consensus criteria to better distinguish the highly lethal subset of primary localized gastrointestinal stromal tumors: a subdivision of the original high-risk group on the basis of outcome. Surgery 141:748–756CrossRef
15.
Hermanek P, Wittekind C (1994) The pathologist and the residual tumor (R) classification. Pathol Res Pract 190:115–123CrossRef
16.
Gouveia AM, Pimenta AP, Capelinha AF, de la Cruz D, Silva P, Lopes JM (2008) Surgical margin status and prognosis of gastrointestinal stromal tumor. World J Surg 32:2375–2382CrossRef
17.
DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF (2000) Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 231:51–58CrossRef
18.
Bauer S, Rutkowski P, Hohenberger P, Miceli R, Fumagalli E, Siedlecki JA, Nguyen BP, Kerst M, Fiore M, Nyckowski P, Hoiczyk M, Cats A, Casali PG, Treckmann J, van Coevorden F, Gronchi A (2014) Long-term follow-up of patients with GIST undergoing metastasectomy in the era of imatinib—analysis of prognostic factors (EORTC-STBSG collaborative study). Eur J Surg Oncol 40:412–419CrossRef
19.
Langer C, Gunawan B, Schuler P, Huber W, Fuzesi L, Becker H (2003) Prognostic factors influencing surgical management and outcome of gastrointestinal stromal tumours. Br J Surg 90:332–339CrossRef
20.
Unalp HR, Derici H, Kamer E, Bozdag AD, Tarcan E, Onal MA (2009) Gastrointestinal stromal tumours: outcomes of surgical management and analysis of prognostic variables. Can J Surg 52:31–38PubMedPubMedCentral
21.
McCarter MD, Antonescu CR, Ballman KV, Maki RG, Pisters PW, Demetri GD, Blanke CD, Von Mehren M, Brennan MF, McCall L (2012) Microscopically positive margins for primary gastrointestinal stromal tumors: analysis of risk factors and tumor recurrence. J Am Coll Surg 215:53–59CrossRef
22.
Cananzi FC, Lorenzi B, Belgaumkar A, Benson C, Judson I, Mudan S (2014) Prognostic factors for primary gastrointestinal stromal tumours: are they the same in the multidisciplinary treatment era? Langenbeck’s Arch Surg 399:323–332CrossRef
23.
Park JJ (2016) Long-term outcomes after endoscopic treatment of gastric gastrointestinal stromal tumor. Clin Endosc 49:232–234CrossRef
24.
European Sarcoma Network Working Group (ESMO) (2012) Gastrointestinal stromal tumors: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 23(Suppl 7):vii49–55
25.
European Sarcoma Network Working Group (ESMO) (2014) Gastrointestinal stromal tumours: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 25(Suppl 3):iii21–i26CrossRef
26.
Faulx AL, Kothari S, Acosta RD, Agrawal D, Bruining DH, Chandrasekhara V, Eloubeidi MA, Fanelli RD, Gurudu SR, Khashab MA, Lightdale JR, Muthusamy VR, Shaukat A, Qumseya BJ, Wang A, Wani SB, Yang J, DeWitt JM (2017) The role of endoscopy in subepithelial lesions of the GI tract. Gastrointest Endosc 85:1117–1132CrossRef
27.
Sakamoto Y, Sakaguchi Y, Akimoto H, Chinen Y, Kojo M, Sugiyama M, Morita K, Saeki H, Minami K, Soejima Y (2012) Safe laparoscopic resection of a gastric gastrointestinal stromal tumor close to the esophagogastric junction. Surg Today 42:708–711CrossRef
28.
Lu J, Jiao T, Li Y, Liu Y, Wang Y, Zheng M, Lu X (2015) Heading toward the right direction–solution package for endoscopic submucosal tunneling resection in the stomach. PLoS ONE 10:e0119870CrossRef
29.
Lu J, Zheng M, Jiao T, Wang Y, Lu X (2014) Transcardiac tunneling technique for endoscopic submucosal dissection of gastric fundus tumors arising from the muscularis propria. Endoscopy 46:888–892CrossRef
30.
Goto O, Shimoda M, Sasaki M, Kiguchi Y, Mitsunaga Y, Akimoto T, Ochiai Y, Fujimoto A, Maehata T, Nishizawa T, Takeuchi H, Kitagawa Y, Kameyama K, Yahagi N (2017) Potential for peritoneal cancer cell seeding in endoscopic full-thickness resection for early gastric cancer. Gastrointest Endosc 87:450–456CrossRef
31.
Jeong IH, Kim JH, Lee SR, Kim JH, Hwang JC, Shin SJ, Lee KM, Hur H, Han SU (2012) Minimally invasive treatment of gastric gastrointestinal stromal tumors: laparoscopic and endoscopic approach. Surg Laparosc, Endosc Percutaneous Tech 22:244–250CrossRef
Metadata
Title
Microscopic positive tumor margin does not increase the rate of recurrence in endoscopic resected gastric mesenchymal tumors compared to negative tumor margin
Authors
Yan Zhu
Mei-Dong Xu
Chen Xu
Xiao-Cen Zhang
Shi-Yao Chen
Yun-Shi Zhong
Yi-Qun Zhang
Wei-Feng Chen
Tian-Yin Chen
Jia-Xin Xu
Li-Qing Yao
Quan-Lin Li
Ping-Hong Zhou
Publication date
01-01-2020
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 1/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-06744-8

Other articles of this Issue 1/2020

Surgical Endoscopy 1/2020 Go to the issue

2018 SAGES Oral

Multicenter collaborative retrospective evaluation of peroral endoscopic myotomy for esophageal achalasia: analysis of data from more than 1300 patients at eight facilities in Japan

OriginalPaper

A comprehensive review of robotic surgery curriculum and training for residents, fellows, and postgraduate surgical education

Review Article

Muscle activation during traditional laparoscopic surgery compared with robot-assisted laparoscopic surgery: a meta-analysis

OriginalPaper

Comparison of transoral endoscopic thyroidectomy vestibular approach, total endoscopic thyroidectomy via areola approach, and conventional open thyroidectomy: a retrospective analysis of safety, trauma, and feasibility of central neck dissection in the treatment of papillary thyroid carcinoma

OriginalPaper

Mesenteric excision of upper esophagus: a concept for rational anatomical lymphadenectomy of the recurrent laryngeal nodes in thoracoscopic esophagectomy

OriginalPaper

ERCP-related perforation: an analysis of operative outcomes in a large series over 12 years