A team of Chinese researchers, when comparing surgical resection to endoscopic resection for patients with gastrointestinal stromal tumors (GISTs) between the sizes of 2 cm and 5 cm, found that surgical resection outperformed endoscopic resection, according to a study published in Frontiers in Oncology. 

The debate between the utility of surgical resection vs endoscopic resection for GIST has heated up lately, even as endoscopic resection becomes more commonly performed for the removal of small GISTs. However, the latest guidelines of the National Comprehensive Cancer Network and the European Society for Medical Oncology still recommend surgical resection for primary localized GISTs larger than 2 cm.

The Chinese research team noted that “currently no high-level studies supporting a clear best choice for [2 to 5-cm] GISTs” are available, as studies have focused mostly on GISTs smaller than 2 cm.

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The researchers thus decided to investigate the best resection method for 2-5 cm GISTs. They conducted a retrospective cohort study based on prospectively collected data of GIST patients at Shandong Provincial Hospital in China. They recruited 302 patients with 2-5 cm GISTs. Among them, 67 underwent endoscopic resection and 215 underwent surgical resection. Propensity matching was performed. 

The study found that operation time and hospital stay were significantly longer in the surgical resection group than in the endoscopic resection group. However, no statistical differences were detected between the groups in terms of blood loss, resection margin, or time to liquid diet.

The researchers also found that patients who underwent endoscopic resection were at a higher risk of suffering from adverse events than patients who underwent surgical resection. Examples of adverse events included intraoperative bleeding, perforation, tumor rupture, and tumor remnants. 

Considering the higher risk of adverse effects in patients who underwent endoscopic resection, the research team wrote, “Endoscopic resection is not currently recommended as a routine treatment for GISTs, and surgical resection is still considered the standard treatment for [2 to 5-cm] GISTs by most guidelines.” 


Wu H, Li H, Xu Q, et al. Surgical resection is still better than endoscopic resection for patients with 2-5 cm gastric gastrointestinal stromal tumours: a propensity score matching analysisFront Oncol. 2021;11:737885. doi:10.3389/fonc.2021.737885