Comparison Among Endoscopic, Laparoscopic, and Open Resection for Relatively Small Gastric Gastrointestinal Stromal Tumors (<5 cm): A Bayesian Network Meta-Analysis

BackgroundEndoscopic resection (ESR) is a novel minimally invasive procedure for superficial tumors. Its safety, efficiency, and outcome for gastric gastrointestinal stromal tumors (gGISTs) less than 5 cm remains unclear compared to laparoscopic resection (LAR) and open resection (ONR). The current...

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Autores principales: Zhen Liu, Ziyang Zeng, Siwen Ouyang, Zimu Zhang, Juan Sun, Xianze Wang, Xin Ye, Weiming Kang, Jianchun Yu
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Publicado: Frontiers Media S.A. 2021
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spelling oai:doaj.org-article:e281e9a570614861b55243589bcf50c62021-12-01T13:58:37ZComparison Among Endoscopic, Laparoscopic, and Open Resection for Relatively Small Gastric Gastrointestinal Stromal Tumors (<5 cm): A Bayesian Network Meta-Analysis2234-943X10.3389/fonc.2021.672364https://doaj.org/article/e281e9a570614861b55243589bcf50c62021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fonc.2021.672364/fullhttps://doaj.org/toc/2234-943XBackgroundEndoscopic resection (ESR) is a novel minimally invasive procedure for superficial tumors. Its safety, efficiency, and outcome for gastric gastrointestinal stromal tumors (gGISTs) less than 5 cm remains unclear compared to laparoscopic resection (LAR) and open resection (ONR). The current network meta-analysis aimed to review and analyze the available evidence of this question.MethodsPubMed, Embase, Cochrane Library, and Web of Science databases were searched to identify eligible studies published up to July 6, 2020. The perioperative and long-term oncological outcomes among ESR, LAR, and ONR for gGIST (&lt;5 cm) were estimated through the Bayesian network meta-analysis with a random-effect model.ResultsFifteen studies with 1,631 patients were included. ESR was associated with a shorter operative time [mean difference, MD: -36; 95% confidence interval, CI (-55, -16)], a higher rate of positive margin [odds ratio, OR: 5.1 × 1010, 95% CI (33, 2.5 × 1032)], and less costs [MD: -1 × 104, 95% CI (-1.6 × 104, -4.4 × 103)] but similar time to resume flatus [MD: 0.52, 95% CI (-0.16, 1.1)] and diet [MD: -3.5, 95% CI (-5.6, -1.6)] compared to LAR. A higher rate of total complications [OR: 11, 95% CI (1.2, 140)] was observed in patients who received ESR compared to patients who received LAR. After excluding perforation from the total complication category, the difference of complication between ESR and LAR disappeared [OR: 0.87, 95% CI (0.22, 2.3)]. The recurrence rate [OR: 1.3, 95% CI (0.40, 4.5)] and disease-free survival [hazard ratio: 1.26, 95% CI (0.60, 2.63)] showed no significant difference between ESR and LAR. ESR was associated with better or equivalent perioperative and long-term outcomes compared to ONR, except for positive margin. A subgroup analysis (&lt;2 and 2–5 cm) showed no significantly different results among these three procedures either.ConclusionESR was shown to be a safe and efficient alternative procedure to both LAR and ONR for gGISTs less than 2 cm and within 2–5 cm, respectively, without worsening the oncologic outcomes. However, preoperative assessment of tumor site is of importance for the determination of procedures regarding the increased incidence of a positive margin related to ESR.Zhen LiuZiyang ZengSiwen OuyangZimu ZhangJuan SunXianze WangXin YeWeiming KangJianchun YuFrontiers Media S.A.articleendoscopic resectionlaparoscopic resectionopen resectiongastric gastrointestinal stromal tumornetwork meta-analysisNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENFrontiers in Oncology, Vol 11 (2021)
institution DOAJ
collection DOAJ
language EN
topic endoscopic resection
laparoscopic resection
open resection
gastric gastrointestinal stromal tumor
network meta-analysis
Neoplasms. Tumors. Oncology. Including cancer and carcinogens
RC254-282
spellingShingle endoscopic resection
laparoscopic resection
open resection
gastric gastrointestinal stromal tumor
network meta-analysis
Neoplasms. Tumors. Oncology. Including cancer and carcinogens
RC254-282
Zhen Liu
Ziyang Zeng
Siwen Ouyang
Zimu Zhang
Juan Sun
Xianze Wang
Xin Ye
Weiming Kang
Jianchun Yu
Comparison Among Endoscopic, Laparoscopic, and Open Resection for Relatively Small Gastric Gastrointestinal Stromal Tumors (<5 cm): A Bayesian Network Meta-Analysis
description BackgroundEndoscopic resection (ESR) is a novel minimally invasive procedure for superficial tumors. Its safety, efficiency, and outcome for gastric gastrointestinal stromal tumors (gGISTs) less than 5 cm remains unclear compared to laparoscopic resection (LAR) and open resection (ONR). The current network meta-analysis aimed to review and analyze the available evidence of this question.MethodsPubMed, Embase, Cochrane Library, and Web of Science databases were searched to identify eligible studies published up to July 6, 2020. The perioperative and long-term oncological outcomes among ESR, LAR, and ONR for gGIST (&lt;5 cm) were estimated through the Bayesian network meta-analysis with a random-effect model.ResultsFifteen studies with 1,631 patients were included. ESR was associated with a shorter operative time [mean difference, MD: -36; 95% confidence interval, CI (-55, -16)], a higher rate of positive margin [odds ratio, OR: 5.1 × 1010, 95% CI (33, 2.5 × 1032)], and less costs [MD: -1 × 104, 95% CI (-1.6 × 104, -4.4 × 103)] but similar time to resume flatus [MD: 0.52, 95% CI (-0.16, 1.1)] and diet [MD: -3.5, 95% CI (-5.6, -1.6)] compared to LAR. A higher rate of total complications [OR: 11, 95% CI (1.2, 140)] was observed in patients who received ESR compared to patients who received LAR. After excluding perforation from the total complication category, the difference of complication between ESR and LAR disappeared [OR: 0.87, 95% CI (0.22, 2.3)]. The recurrence rate [OR: 1.3, 95% CI (0.40, 4.5)] and disease-free survival [hazard ratio: 1.26, 95% CI (0.60, 2.63)] showed no significant difference between ESR and LAR. ESR was associated with better or equivalent perioperative and long-term outcomes compared to ONR, except for positive margin. A subgroup analysis (&lt;2 and 2–5 cm) showed no significantly different results among these three procedures either.ConclusionESR was shown to be a safe and efficient alternative procedure to both LAR and ONR for gGISTs less than 2 cm and within 2–5 cm, respectively, without worsening the oncologic outcomes. However, preoperative assessment of tumor site is of importance for the determination of procedures regarding the increased incidence of a positive margin related to ESR.
format article
author Zhen Liu
Ziyang Zeng
Siwen Ouyang
Zimu Zhang
Juan Sun
Xianze Wang
Xin Ye
Weiming Kang
Jianchun Yu
author_facet Zhen Liu
Ziyang Zeng
Siwen Ouyang
Zimu Zhang
Juan Sun
Xianze Wang
Xin Ye
Weiming Kang
Jianchun Yu
author_sort Zhen Liu
title Comparison Among Endoscopic, Laparoscopic, and Open Resection for Relatively Small Gastric Gastrointestinal Stromal Tumors (<5 cm): A Bayesian Network Meta-Analysis
title_short Comparison Among Endoscopic, Laparoscopic, and Open Resection for Relatively Small Gastric Gastrointestinal Stromal Tumors (<5 cm): A Bayesian Network Meta-Analysis
title_full Comparison Among Endoscopic, Laparoscopic, and Open Resection for Relatively Small Gastric Gastrointestinal Stromal Tumors (<5 cm): A Bayesian Network Meta-Analysis
title_fullStr Comparison Among Endoscopic, Laparoscopic, and Open Resection for Relatively Small Gastric Gastrointestinal Stromal Tumors (<5 cm): A Bayesian Network Meta-Analysis
title_full_unstemmed Comparison Among Endoscopic, Laparoscopic, and Open Resection for Relatively Small Gastric Gastrointestinal Stromal Tumors (<5 cm): A Bayesian Network Meta-Analysis
title_sort comparison among endoscopic, laparoscopic, and open resection for relatively small gastric gastrointestinal stromal tumors (<5 cm): a bayesian network meta-analysis
publisher Frontiers Media S.A.
publishDate 2021
url https://doaj.org/article/e281e9a570614861b55243589bcf50c6
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