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

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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.

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Abbreviations

ESE:

Endoscopic submucosal excavation

STER:

Submucosal tunnel endoscopic resection

EFTR:

Endoscopic full-thickness resection

GIST:

Gastrointestinal stromal tumor

GIMT:

Gastrointestinal mesenchymal tumor

RFS:

Recurrence-free survival

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Funding

This study was supported by grants from the National Natural Science Foundation of China (Grant Nos. 81873552, 81470811, 81570595, and 81670483), Major Project of Shanghai Municipal Science and Technology Committee (Grant Nos. 18ZR1406700, 16411950400, and 15JC1490300), Chen Guang Program of Shanghai Municipal Education Commission (Grant No. 15CG04), and Outstanding Young Doctor Training Project of Shanghai Municipal Commission of Health and Family Planning (Grant No. 2017YQ026).

Author information

Correspondence to Quan-Lin Li or Ping-Hong Zhou.

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Disclosures

Drs. 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, and Ping-Hong Zhou declare that there is no conflict of interest.

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Zhu, Y., Xu, M., Xu, C. et al. Microscopic positive tumor margin does not increase the rate of recurrence in endoscopic resected gastric mesenchymal tumors compared to negative tumor margin. Surg Endosc 34, 159–169 (2020). https://doi.org/10.1007/s00464-019-06744-8

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Keywords

  • Gastrointestinal mesenchymal tumor
  • Gastrointestinal stromal tumor
  • Endoscopic submucosal excavation
  • Submucosal tunnel endoscopic resection
  • Endoscopic full-thickness resection
  • R0 resection