Gastric Cancer: Risk factors for failure of endoscopic resection of gastric submucosal tumors

Gastric submucosal tumors refer to tumors originating below the gastric mucosal layer, mainly including gastrointestinal stromal tumors, neurogenic tumors, leiomyomas, and lipomas
.
Most patients have no clinical symptoms and are found incidentally on upper endoscopy; However, malignant transformation of gastric mesenchymal stem cells (GIST) is the most common
.
Some benign tumors can also cause abdominal pain, bleeding and other clinical manifestations
.
According to guidelines developed by the National Comprehensive Cancer Network (NCCN), resection is the treatment of choice for non-metastatic GIST > 2 cm
.
However, <2cm GIST lacks the high-risk features of endoscopic ultrasound (EUS) and only needs to be monitored every 1-2 years, unfortunately, long-term follow-up can cause patients to feel anxious
.
Endoscopic resection (ER) is a minimally invasive treatment characterized by less trauma, high overall resection rate, fast postoperative recovery, few adverse events, and good
long-term results.
Most G-SMTs do not cause lymph node metastasis and can be removed directly without lymph node dissection
.
Therefore, ER has become a suitable option
for the treatment of small G-SMTs.
Therefore, this study aimed to study the characteristics of G-SMT patients receiving ER therapy and aimed to identify risk factors
for ER failure in these patients.

A total of 1041 patients with G-SMT who underwent endoscopic resection were enrolled in this study
.
In the end, 25 patients who failed endoscopic resection and needed to be transferred to surgery in the middle of surgery were the failure group, and 1016 patients who had successful endoscopic resection were in the successful endoscopic resection group
.
Finally, the researchers recorded the baseline and lesion characteristics of all patients, and analyzed the differences in tumor characteristics and risk factors
for failure of G-SMT resection.

The results of the study showed that of the 1041 patients included, 25 (2.
4%)
failed endoscopic resection.
Binary logical analysis showed that independent risk factors included tumors originating in the deep muscular lamina propria (OR=14.
42, 95% CI 4.
47–46.
52), size > 3 cm (OR=7.
75, 95% CI 2.
64–22.
70), exophytic growth patterns (OR=4.
98, 95% CI 1.
62–15.
29), less experienced endoscopists (OR=5.
99, 95% CI 1.
07–12.
19), and irregular borders (OR = 4.
13, 95% CI 1.
40–12.
19)
。 According to sensitivity analysis, the most important risk factors are tumor size, tumor origin, and growth pattern
.

This study confirmed that tumors originating in the deep muscular lamina propria, tumor size > 3 cm, less experienced endoscopists, exophytic growth patterns, and irregular margins were found to be independent risk factors for
failure of endoscopic resection.
To reduce the risk of failure of endoscopic resection, the physician should carefully evaluate the G-SMT feature
before surgery.

Original source:

Yuzhu Yuan.
et al.
Risk factors for the failure of endoscopic resection of gastric submucosal tumors: a long-term retrospective case–control study.
Gastric Cancer.
2022.