Published online Mar 7, 2021. doi: 10.3748/wjg.v27.i9.854
Peer-review started: November 28, 2020
First decision: January 17, 2021
Revised: January 23, 2021
Accepted: February 11, 2021
Article in press: February 11, 2021
Published online: March 7, 2021
Various surgical procedures have been described for gastrointestinal stromal tumors (GISTs) at the esophagogastric junction (EGJ) close to the Z-line. However, surgery for EGJ-GIST involving Z-line has been rarely reported.
To introduce a novel technique called conformal resection (CR) for open resection of EGJ-GIST involving Z-line.
In this retrospective study, 43 patients having GISTs involving Z-line were included. The perioperative outcomes of patients receiving CR (n = 18) was compared with that of proximal gastrectomy (PG) (n = 25).
CR was successfully performed in all the patients with negative microscopic margins. The mean operative time, time to first passage of flatus, and postoperative hospital stay was significantly shorter in the CR group (P < 0.05), while the intraoperative blood loss was similar in the two groups. The postoperative gastroesophageal reflux as diagnosed by esophageal 24-h pH monitoring and quality of life at 3 mo were significantly in favor of CR compared to PG (both P < 0.001). The 5-year disease-free survival between the two groups was similar (P = 0.163). The cut- off value for the determination of CR or PG was 7.0 mm above the Z-line (83.33% sensitivity, 84.00% specificity, 83.72% accuracy).
CR is safe and feasible for EGJ-GIST located within 7.0 mm above the Z-line.
Core Tip: We retrospectively enrolled 43 cases of esophagogastric junction-gastrointestinal stromal tumor (EGJ-GIST) involving Z-line, including 25 cases in the proximal gastrectomy (PG) group and 18 cases in the conformal resection (CR) group. The operation CR was introduced, and the following indicators were analyzed: Clinicopathological characteristics, perioperative outcomes, postoperative esophageal 24-h pH, postoperative quality of life, and 5-year disease-free survival. Finally, the cut-off value above the Z-line for the determination of CR or PG was determined. Our results confirm that CR is safe and feasible for EGJ-GIST located within 7.0 mm above the Z-line. CR was associated with lower incidence of postoperative gastroesophageal reflux and better quality of life with similar oncological outcomes compared to PG.