Endoscopic versus laparoscopic resection of gastrointestinal stromal tumors at the esophagogastric junction using propensity score matching analysis

Abstract

The esophagogastric junction (EGJ) has a complex anatomy and critical physiological functions, making postoperative quality of life an important consideration in the surgical resection of gastrointestinal stromal tumors at this location (EGJ-GISTs). We conducted a propensity score-matched (1:1) analysis to compare the safety and efficacy of endoscopic resection (ER) and laparoscopic resection (LR) for patients with EGJ-GIST treated at the First Affiliated Hospital of Zhengzhou University, China, from December 2013 to November 2023. We reviewed 176 patients (ER 82; LR 94) with EGJ-GIST, of whom 85 patients with a tumor size of 2–5 cm met the matching criteria (ER 42; LR 43), yielding 20 pairs of patients. ER showed advantages over LR, with a shorter postoperative nil per os time (4.0 days (IQRs, 3.0–5.0) vs. 5.5 days (IQRs, 4.3–7.8), p = 0.005) and postoperative hospitalization time (6.0 days (IQRs, 5.0−6.8) vs. 8.5 days (IQRs, 6.0−11.8, p = 0.002). Long-term adverse events were significantly lower in the ER group (15% vs. 55%, p = 0.005). No recurrence or metastasis was observed in either group during a mean follow-up of 42.3 months. These findings suggest that for 2–5 cm EGJ-GISTs, ER is a safe and effective alternative, offering minimal invasiveness, faster recovery, fewer complications, and improved long-term quality of life.