Correlation of preoperative CT features with intra- and postoperative parameters of endoscopic resection in patients with gastric submucosal tumor (1~3 cm)

• Published in: Surgical endoscopy Vol. 39; no. 1; pp. 259 - 268
• Main Authors: Chen, Yuxiang, Chen, Mo, Wang, Zhu, Wu, Junchao, Yang, Jinlin, Yang, Li, Deng, Kai
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.01.2025; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Aged; Antibiotics; Endoscopic Mucosal Resection - methods; Endoscopy; Endosonography; Female; Gastric Mucosa - diagnostic imaging; Gastric Mucosa - pathology; Gastric Mucosa - surgery; Gastroenterology; Gastroscopy - methods; Gerontology; Gynecology; Hepatology; Humans; Length of Stay - statistics & numerical data; Localization; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Operative Time; Ostomy; Patients; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Preoperative Care - methods; Proctology; Retrospective Studies; Statistical analysis; Stomach Neoplasms - diagnostic imaging; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Surgery; Tomography, X-Ray Computed; Tumors; Ultrasonic imaging; CT features; Ultrasound endoscopy; Submucosal tumors; Perioperative indicators
• ISSN: 0930-2794; 1432-2218; 1432-2218
• DOI: 10.1007/s00464-024-11349-x

Objectives Endoscopic resection of gastric submucosal tumors (SMTs) possesses minimal trauma, expedited recovery, and reduced costs. Nonetheless, intraoperative challenges, including imprecise surgical risk assessment, prevail. Hence, we investigated the correlation between preoperative CT observation features and perioperative parameters for predicting outcomes in SMT patients. Methods Subjects diagnosed with SMT and undergoing endoscopic surgery conducted at West China Hospital's Endoscopy Center from September 2019 to October 2023 were retrospectively selected. Endoscopic ultrasonography (EUS) and computer tomography (CT) were utilized for evaluating SMT. The study assessed the correlation between preoperative CT findings and perioperative parameters. Results Increased lesion size on contrast-enhanced CT correlates with increased operative duration, hospital stay, postoperative antibiotic use. Of utmost significance, we observed a significantly higher intraoperative perforation rate for patients with tumor outgrowth compared to those with lesion involvement of the lumen (96.88% vs 29.11%, P  < 0.001). These patients also demonstrated an increased risk of postoperative blood stream infections ( P  = 0.012), necessitating higher antibiotic grade ( P  = 0.048), along with prolonged gastrostomy tube retention ( P  = 0.001) and hospitalization ( P  = 0.018). In addition, CT provides a more accurate and comprehensive assessment of tumor size ( P  = 0.037) and growth pattern ( P  = 0.026) than EUS. Conclusion CT assessment of tumor size closer to reality than EUS. Importantly, these features can assist in pinpointing lesions with elevated surgical complexity and high risk of complications, leading to improved preoperative preparation, thereby increasing anticipation of surgical risks and reducing incidence of complications.