Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor originating from the gastrointestinal tract, mainly associated with KIT and PDGFRA gene mutations, and related to factors such as patient age, gender, and pathological differentiation level. The clinical manifestations of GIST include abdominal pain, indigestion, gastrointestinal bleeding, etc. The diagnostic methods involve endoscopy, imaging examination, and pathological evaluation. The treatment strategy for GIST is customized based on tumor characteristics and individual circumstances, including surgery, drug therapy, and targeted therapy. With the development of molecular biology, the understanding of GIST has become increasingly profound, and various diagnostic techniques and treatments for GIST have made new progress, especially in individualization, precision medicine, and targeted therapy.

Objective:To analyze the clinical efficacy of endoscopic submucosal dissection (ESD) in the treatment of gastrointestinal submucosal tumors (SMT).Methods:A retrospective analysis was conducted on the clinical data of 114 SMT patients who underwent ESD treatment at the Endoscopy Center of the Shulan (Hangzhou) Hospital from January 1, 2023 to December 31, 2023. The use of mucosal incision during surgery, surgical related indicators, and postoperative recovery were observed.Results:The age of the patients in this group ranged from 22-84(61.0±12.0)years old, with 62 males and 52 females. Tumors were located in 5 cases of esophagus, 2 cases of cardia, 11 cases of gastric fundus, 7 cases of gastric body, 3 cases of gastric angle, 13 cases of gastric antrum, 38 cases of colon, 11 cases of sigmoid colon, and 24 cases of rectum. All tumors were located in the submucosal layer, with 55 cases of benign lesions, 44 cases of precancerous lesions, and 15 cases of malignant tumor lesions. All patients successfully completed the surgery without any serious complications or deaths. During the operation, 59 cases used Dual knives, the surgical cost was 5 082.44-12 515.51(8 657.34±1 471.23)yuan, the total hospitalization cost was 10 878.02-32 310.74(18 934.47±4 404.21)yuan; 55 cases used snare devices, the surgical cost was 3 159.87-9 970.71(5 597.37±1 587.78)yuan, the total hospitalization cost was 6 985.92-40 309.26(13 807.12±5 213.76)yuan, the surgical time was 18-204(63.07±35.48)minutes; there were 22 cases of intraoperative bleeding, 8 cases of intraoperative perforation, 36 cases of fasting for 48 hours after surgery, 78 cases of fasting for 72 hours after surgery, and the postoperative hospitalization time was 3-16(6.91±2.38)days. Postoperative complications such as abdominal pain, bloating, and fever occurred in 14 cases. After surgery, 5 patients underwent surgical salvage surgery due to pathological indications of malignant tumors with infiltration depth>500 μm (>1 000 μm in the colon).Conclusions:ESD treatment for SMT is safe and feasible. For different sizes of gastrointestinal SMT, each endoscopic center and surgeon should comprehensively consider factors such as tumor characteristics, treatment effectiveness, and cost-effectiveness balance when selecting the corresponding surgical type and consumables.

Objective:To explore the application value of intraoperative ultrasound localization in laparoscopic surgery for non extraluminal gastrointestinal stromal tumors.Methods:A retrospective analysis was conducted on the clinical data of 13 patients with non extraluminal gastrointestinal stromal tumors treated with laparoscopic surgery at Zhejiang Provincial People′s Hospital from January 2023 to March 2024. Ultrasound localization was used during the surgery. An analysis was conducted on indicators such as the patient′s surgical approach, surgical duration, intraoperative blood loss, time of first postoperative meal intake, length of hospital stay, and incidence of postoperative complications.Results:Among the 13 patients, there were 7 males and 6 females, and all patients successfully completed the surgery. The operation time was (71.54±19.51)minutes, the intraoperative blood loss was (20.0±16.8)ml, the first postoperative feeding time was (3.08±1.38)days, and the postoperative hospitalization time was (6.92±2.69)days. All 13 patients did not undergo conversion to open surgery during the operation, and the operation was smooth. There was no major bleeding or iatrogenic injury during the operation. There was no bleeding, abdominal infection, anastomotic fistula, anastomotic stenosis, etc. after the operation. There were no unplanned cases of reoperation, and all recovered well and were discharged smoothly. There were no discomfort symptoms during the 3-month follow-up after the operation.Conclusions:Intraoperative ultrasound can accurately locate tumors in laparoscopic non cavity growth gastrointestinal stromal tumor surgery, which is beneficial for the smooth progress of the surgery and the formulation of surgical strategies, and has obvious safety and reliability.

Objective:To compare the therapeutic effects of surgical resection combined with tyrosine kinase inhibitors (TKI) and TKI alone in patients with recurrent or metastatic gastrointestinal stromal tumors (GIST).Methods:Literature was searched in databases such as PubMed and Web of Science, and relevant literature on the application of surgical resection combined with TKI and TKI alone in patients with recurrent or metastatic GIST was selected strictly according to inclusion criteria. Meta analysis was conducted on the survival benefits of patients, including progression free survival (PFS) and overall survival (OS).Results:A total of 647 patients from 8 studies were included in this meta-analysis, with 6 studies conducted in Asia and 2 in Europe. The Newcastle Ottawa Quality Assessment Scale scores were all ≥6. Eight studies were conducted to evaluate the overall survival of patients treated with surgical resection combined with TKI and TKI alone, with four studies simultaneously assessing PFS. The meta-analysis results showed that compared with TKI treatment alone, surgical resection combined with TKI treatment significantly improved the overall survival (OS) of patients with recurrent or metastatic GIST ( P<0.001). Conclusions:For patients with recurrent or metastatic GIST, compared to simple TKI treatment, surgical resection of residual lesions after TKI (such as imatinib) control of the condition brings significant survival benefits to patients. Combining surgical intervention with TKI treatment should be considered a feasible treatment strategy to improve the prognosis of patients with recurrent or metastatic GIST.

Objective:To investigate the efficacy and safety of endoscopic submucosal tumor resection without labeling and submucosal injection (NMSI-ESE) in the treatment of gastric small gastrointestinal stromal tumors.Methods:A retrospective analysis was conducted on the clinical data of 49 patients diagnosed with gastric small gastrointestinal stromal tumors in the Department of Gastrointestinal Surgery at the Shulan (Hangzhou) Hospital from January 2019 to December 2023. Among them, 23 cases underwent NMSI-ESE and 26 cases underwent traditional endoscopic submucosal tumor resection (ESE). We compared the clinical and pathological characteristics, surgical time, tumor removal time, number of metal clips used, surgical costs, postoperative hospitalization time, and incidence of complications between two groups of patients.Results:Compared with the ESE group, the NMSI-ESE group had shorter surgical time [38.95(26.50, 53.25)min vs 47.30(38.50, 52.25)min, Z=-2.60, P=0.011], shorter tumor removal time [17.27(8.75, 24.50)min vs 27.08(18.75, 35.00)min, Z=-4.32, P<0.001], and lower surgical costs [3 308(3.190, 3 450)yuan vs 4 107(3 972, 4 232)yuan, Z=-20.95, P<0.001], fewer metal clips used [(3.86±0.91) vs (5.04±1.22), t=-4.00, P<0.001], and shorter postoperative hospitalization time [3.1(2.0, 4.0)d vs 3.5(3.0, 4.0)d, Z=-2.20, P=0.031], There was no statistically significant difference in R0 resection rate and postoperative complications (all P>0.05). During the follow-up period, both groups of patients had no tumor recurrence or metastasis. Conclusions:NMSI-ESE is safe and effective in treating small gastrointestinal stromal tumors, and can shorten surgical and hospitalization time, as well as reduce medical costs compared to traditional ESE.

Gastrointestinal reconstruction is an important step in radical gastrectomy for gastric cancer. This article reviews the digestive tract reconstruction methods of total gastrectomy, distal gastrectomy, and proximal gastrectomy, and summarizes various functional preservation gastrectomy techniques that have been continuously developed in recent years. Finally, based on the author′s relevant experience, the surgical methods designed in total gastrectomy and distal gastrectomy are introduced.

Objective:To investigate the clinical efficacy of total endoscopic resection of gastric stromal tumors with cosmetic suture reconstruction.Methods:The data of 18 patients who underwent total laparoscopic resection of gastric stromal tumors with cosmetic suture reconstruction from December 2020 to May 2023 in Zhejiang Provincial People′s Hospital were collected retrospectively, and their clinical efficacy was analyzed.Results:Twelve patients were asymptomatic and the tumor was found during physical examination. All patients underwent total endoscopic resection of gastric stromal tumors with cosmetic suture reconstruction without conversion to open surgery. The time to resume liquid diet was 1-3(1.67±0.35)days, the postoperative hospital stay was 4-12(6.89±2.54)days, and no postoperative complications occurred. Among them, 12 cases were at low risk and 6 cases were at medium risk. CD117 and DOG-1 were positively expressed in all cases. Four out of six patients at medium risk underwent genetic testing, and two patients with c-Kit gene Lys550-Val560 mutation were treated with Gleevec therapy after surgery. Gastrography performed one month after surgery showed that the shape of the stomach was similar to the preoperative shape, with good motility and unimpeded emptying.Conclusions:Total laparoscopic resection of gastric stromal tumors combined with cosmetic suture reconstruction can reduce postoperative gastrointestinal dilatation, esophageal and pyloric stenosis, and has a certain clinical value.

Objective:To explore the feasibility and therapeutic effect of Roux-en-Y anastomosis through a small incision in laparoscopic distal gastrectomy for gastric cancer.Methods:A retrospective analysis was conducted on the clinical data of 34 patients who underwent laparoscopic distal gastrectomy for gastric cancer through Roux-en-Y anastomosis through small incisions in the Gastrointestinal and Pancreatic Surgery Department of the Zhejiang Provincial People′s Hospital from August 2022 to May 2023.Results:Among the 34 patients, there were 27 males and 7 females, aged (63.6±14.6)years old. All cases underwent surgery successfully and there were no cases of conversion to open surgery. The reconstruction time of the digestive tract was (30.74±3.29)minutes, the intraoperative bleeding volume was (60.29±29.59)ml, the intraoperative lymph nodes were cleaned (32.00±11.00), the incision length of the specimen was (5.88±0.98)cm, the postoperative exhaust time was (1.88±0.73)days, and the postoperative hospitalization time was (11.94±3.87)days. There were no postoperative cases of anastomotic leakage, anastomotic stenosis, bleeding, or unplanned reoperation in patients. After a postoperative follow-up of 3-12 months, there were no recurrence or death cases, and no postoperative reflux cases during the follow-up period.Conclusions:Laparoscopic distal gastrectomy with Roux-en-Y anastomosis through a small incision can effectively reduce postoperative complications, especially the occurrence of postoperative reflux. In addition, this surgical procedure can simplify the surgical steps, shorten the surgical time, promote postoperative recovery, and improve postoperative quality of life.

Objective:To introduce the operation process of laparoscopic total gastrectomy assisted by small incision and gastrointestinal reconstruction using tubular instrument anastomosis in esophageal and small bowel reconstruction, and evaluate its feasibility, safety during perioperative period, and advantages of anastomosis.Methods:A total of 56 patients with gastric cancer who underwent laparoscopic total gastrectomy assisted by small incision and gastrointestinal reconstruction using tubular instrument anastomosis in esophageal and small bowel reconstruction were selected as study subjects from Zhejiang Provincial People′s Hospital between May 2022 and June 2023. Gender, age, body mass index (BMI), tumor location, tumor stage, tumor type and other related indicators were collected. The main parameters during the operation process were collected, including operation time, anastomosis time, intraoperative blood loss, postoperative recovery status, exhaust time, feeding time, complications related to anastomosis, and length of hospital stay. The differences between other digestive tract reconstruction methods such as Overlap method, reverse puncture method, and handmade anastomosis were compared and analyzed.Results:A total of 56 patients with gastric cancer were included in this study. The anastomosis time of the tubular instrument group was (42.3±15.7)min, which was superior to the handmade anastomosis group ( P<0.05). The operation time of the tubular instrument group was (176.3±25.8)min, which was superior to other methods (all P<0.05). The intraoperative blood loss of the tubular instrument group was (75.68±20.34)ml, which was less than other methods (all P<0.05). The exhaust time of the tubular instrument group was (2.6±0.2)d, which was similar to the Overlap method ( P>0.05), but earlier than the handmade anastomosis method and the reverse puncture method (all P<0.05). The incidence of anastomotic leakage in the tubular instrument group was similar to the handmade anastomosis method, the reverse puncture method, and the Overlap method (all P>0.05). There were no significant differences in postoperative hospital stay, incision infection rate, and other complications related to anastomosis between groups (all P>0.05). Conclusions:The tubular instrument anastomosis method has a shorter operation time and a smaller incision compared to traditional laparotomy surgery. It has the advantages of laparoscopic assistance with intuitive and clear visualization during the operation, while also taking into account the convenience and safety of direct visualization under laparoscopy. It is a surgical method worthy of promotion.

Objective:To compare the clinical efficacy and quality of life of patients between Billroth Ⅱ+ Braun anastomosis and simple Billroth Ⅱ anastomosis in digestive tract reconstruction after laparoscopic distal gastric cancer radical resection.Methods:A retrospective analysis was performed on clinical data of 68 patients who underwent laparoscopic distal gastric cancer radical resection in Jinjiang Municipal Hospital from January 2019 to January 2022. Forty patients who underwent Billroth Ⅱ+ Braun anastomosis were included in the observation group, and 28 patients who underwent simple Billroth Ⅱ anastomosis were included in the control group. Perioperative indicators and postoperative indicators one year after surgery were collected to observe the safety and efficacy of patients after surgery.Results:There were no significant differences in operation time, intraoperative bleeding volume, postoperative exhaust time, time to remove gastric tube and drainage tube, and postoperative hospital stay between the two groups (all P>0.05). There were also no significant differences in postoperative complications between the two groups ( P>0.05). One year after surgery, the incidence of food retention and residual gastritis in the observation group were lower than those in the control group (all P<0.05), while there were no significant differences in the incidence of bile reflux and reflux esophagitis between the two groups (all P>0.05). One year after surgery, nutritional evaluation showed that the total protein decline and prognostic nutritional index (PNI) in the observation group were lower than those in the control group, with significant differences (all P<0.05). The incidence of bloating and reflux symptoms in the observation group one year after surgery was lower than that in the control group, with significant differences (all P<0.05). Conclusions:Billroth Ⅱ+ Braun anastomosis is a safe method for digestive tract reconstruction after laparoscopic distal gastric cancer resection, which can improve patients′ quality of life after surgery.