A scoring system to predict surgical difficulty in minimally invasive surgery for gastric submucosal tumors

Am J Surg. 2022 Apr;223(4):715-721. doi: 10.1016/j.amjsurg.2021.07.028. Epub 2021 Jul 21.

Abstract

Background: Various minimally invasive surgery (MIS) procedures are used for gastric submucosal tumors (SMTs), and their technical difficulties vary. Preoperative understanding of difficulties is crucial; however, objective indicators are lacking.

Methods: Gastric SMTs requiring MIS (n = 36) were retrospectively analyzed. Preoperative factors were evaluated using a multivariate linear regression analysis. A scoring system was then constructed, and its feasibility was evaluated.

Results: Three factors were identified and scored based on the weighted contribution for predicting surgical time: tumor location (cardia, score of "2"; posterior wall of fundus, "1"); tumor size (greater than 4 cm, "1"); and tumor growth appearance (intraluminal, "1"). The summed scores could stratify the surgical time stepwise in each score, and patients who scored higher than 3 had larger intraoperative blood loss and a longer hospital stay.

Conclusion: Our scoring system predicted surgical difficulties and may, therefore, be useful in selecting appropriate surgical approaches for gastric SMTs.

Keywords: Gastric submucosal tumor; Gastrointestinal stromal tumor (GIST); Minimally invasive surgery; Surgical difficulty score.

MeSH terms

  • Gastrectomy / methods
  • Gastric Mucosa / pathology
  • Gastric Mucosa / surgery
  • Gastrointestinal Stromal Tumors* / pathology
  • Gastrointestinal Stromal Tumors* / surgery
  • Gastroscopy / methods
  • Humans
  • Minimally Invasive Surgical Procedures
  • Retrospective Studies
  • Stomach Neoplasms* / pathology
  • Stomach Neoplasms* / surgery
  • Treatment Outcome