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Abstract：
BACKGROUND: The true impact of surgery for small, asymptomatic and biopsy-negative gastric submucosal tumours (SMTs) with size enlargement during \'watchful waiting\' period has not been fully understood.
METHODS: From 2005 to 2012, 100 patients with gastric SMTs underwent surgery. Twenty-three of them with size enlargement during observation period were enrolled in the retrospective analysis. Data included clinicopathologic findings, genetic findings, operative outcomes and prognoses.
RESULTS: All patients (13 males, 10 females), with median age of 54 (41-71), had their lesions detected by routine health check-up (n=21) or incidentally (2). The tumours were 1.8 (0.5-4.0)cm in size at their initial detection, and enlarged up to 3.2 (2.0-7.0)cm at the operation during 63.0 (14.6-233.7) months. As surgical procedure, laparoscopic partial gastrectomy accounted for the majority (78.3%). Histologic examination revealed gastrointestinal stromal tumour (GIST) (21) and schwannoma (2). Although 16 out of 21 GISTs were categorised into \'Very low\' (1), and \'Low\' (13) risk according to Fletcher\'s classification, \'Intermediate\' (5) and \'High\' (2) risk were identified in the series. No recurrences/metastases were noted in 23.2 (0.9-87) months of postoperative follow-up.
CONCLUSIONS: Our study revealed the existence of high mitotic GISTs in asymptomatic, small gastric SMTs with size enlargement, and laparoscopic surgery was safely applied to majority of those cases. Prompt surgical intervention should therefore be considered for those lesions.
METHODS: From 2005 to 2012, 100 patients with gastric SMTs underwent surgery. Twenty-three of them with size enlargement during observation period were enrolled in the retrospective analysis. Data included clinicopathologic findings, genetic findings, operative outcomes and prognoses.
RESULTS: All patients (13 males, 10 females), with median age of 54 (41-71), had their lesions detected by routine health check-up (n=21) or incidentally (2). The tumours were 1.8 (0.5-4.0)cm in size at their initial detection, and enlarged up to 3.2 (2.0-7.0)cm at the operation during 63.0 (14.6-233.7) months. As surgical procedure, laparoscopic partial gastrectomy accounted for the majority (78.3%). Histologic examination revealed gastrointestinal stromal tumour (GIST) (21) and schwannoma (2). Although 16 out of 21 GISTs were categorised into \'Very low\' (1), and \'Low\' (13) risk according to Fletcher\'s classification, \'Intermediate\' (5) and \'High\' (2) risk were identified in the series. No recurrences/metastases were noted in 23.2 (0.9-87) months of postoperative follow-up.
CONCLUSIONS: Our study revealed the existence of high mitotic GISTs in asymptomatic, small gastric SMTs with size enlargement, and laparoscopic surgery was safely applied to majority of those cases. Prompt surgical intervention should therefore be considered for those lesions.
摘要：
背景：手术的真正影响小，无症状和活检阴性的胃粘膜下肿瘤（SMTs）在“观察等待”期间大小增大尚未完全了解。
方法：从2005年到2012年，100例胃SMTs患者接受了手术。其中有23例在观察期间增大，纳入回顾性分析。数据包括临床病理发现，遗传发现,手术结果和预后。
结果：所有患者（13名男性，10名女性），年龄中位数为54岁（41-71岁），通过常规健康检查（n=21）或偶然检查（2）发现了他们的病变。最初检测到的肿瘤大小为1.8（0.5-4.0）厘米，在63.0（14.6-233.7）个月内，手术时扩大至3.2（2.0-7.0）cm。作为外科手术,腹腔镜胃部分切除术占多数(78.3%)。组织学检查显示胃肠道间质瘤（GIST）（21）和神经鞘瘤（2）。尽管21个GIST中有16个被归类为“非常低”(1)，根据弗莱彻的分类，和“低”(13)风险，在系列中确定了“中间”（5）和“高”（2）风险。术后随访23.2（0.9-87）个月，未发现复发/转移。
结论：我们的研究揭示了在无症状，大小增大的小胃SMT，腹腔镜手术安全地应用于大多数这些病例。因此，应考虑对这些病变进行及时的手术干预。
方法：从2005年到2012年，100例胃SMTs患者接受了手术。其中有23例在观察期间增大，纳入回顾性分析。数据包括临床病理发现，遗传发现,手术结果和预后。
结果：所有患者（13名男性，10名女性），年龄中位数为54岁（41-71岁），通过常规健康检查（n=21）或偶然检查（2）发现了他们的病变。最初检测到的肿瘤大小为1.8（0.5-4.0）厘米，在63.0（14.6-233.7）个月内，手术时扩大至3.2（2.0-7.0）cm。作为外科手术,腹腔镜胃部分切除术占多数(78.3%)。组织学检查显示胃肠道间质瘤（GIST）（21）和神经鞘瘤（2）。尽管21个GIST中有16个被归类为“非常低”(1)，根据弗莱彻的分类，和“低”(13)风险，在系列中确定了“中间”（5）和“高”（2）风险。术后随访23.2（0.9-87）个月，未发现复发/转移。
结论：我们的研究揭示了在无症状，大小增大的小胃SMT，腹腔镜手术安全地应用于大多数这些病例。因此，应考虑对这些病变进行及时的手术干预。
