{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T04:44:45Z","timestamp":1766983485317,"version":"build-2065373602"},"reference-count":30,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2022,8,13]],"date-time":"2022-08-13T00:00:00Z","timestamp":1660348800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Cancer Center, Republic of Korea","award":["NCC-2010150-2"],"award-info":[{"award-number":["NCC-2010150-2"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Depending on the location of gastric subepithelial tumors (SETs), surgical access is difficult with a risk of postoperative complications. This study aimed to evaluate the clinicopathological characteristics of small-sized gastric SETs and their surgical outcomes depending on location and provide considering factors for their treatment plans. Methods: This single-center, retrospective study reviewed patients who underwent surgical resection for gastric SETs (size &lt; 5 cm). SETs were divided into benign SETs and gastrointestinal stromal tumors (GISTs) for comparison. The clinicopathological characteristics of SETs in the cardia were compared to those in the other regions. Results: Overall, 191 patients with gastric SETs (135 GISTs, 70.7%; and 56 benign SETs, 29.3%) were included. In multivariate analysis, age &gt; 65 years (odds ratio (OR), 3.183; 95% confidence interval (CI), 1.310\u20137.735; p = 0.011), and non-cardiac SETs (OR, 2.472; 95% CI, 1.110\u20135.507; p = 0.030) were associated with a significant risk of malignancy. Compared to SETs in other locations, cardiac SETs showed more complications (3 versus 0; p = 0.000), and open conversion rates (2 versus 0; p = 0.003). However, the proportion of GISTs of SETs in the cardia is not negligible (52.9%). Conclusions: Considering the malignancy risk of SETs, active surgical resection should be considered in old age and\/or location in the non-cardiac area. However, in young patients, SETs located in the gastric cardia have a considerably benign nature and are associated with poor short-term surgical outcomes. An individualized surgical approach for asymptomatic small SETs according to the gastric location is warranted.<\/jats:p>","DOI":"10.3390\/jcm11164733","type":"journal-article","created":{"date-parts":[[2022,8,15]],"date-time":"2022-08-15T01:47:21Z","timestamp":1660528041000},"page":"4733","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Necessity of Individualized Approach for Gastric Subepithelial Tumor Considering Pathologic Discrepancy and Surgical Difficulty Depending on the Gastric Location"],"prefix":"10.3390","volume":"11","author":[{"given":"Sung Gon","family":"Kim","sequence":"first","affiliation":[{"name":"Center for Gastric Cancer, National Cancer Center, Goyang-si 10408, Korea"},{"name":"Department of Surgery, Konyang University Hospital, Daejeon 35365, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bang Wool","family":"Eom","sequence":"additional","affiliation":[{"name":"Center for Gastric Cancer, National Cancer Center, Goyang-si 10408, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongman","family":"Yoon","sequence":"additional","affiliation":[{"name":"Center for Gastric Cancer, National Cancer Center, Goyang-si 10408, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3435-3301","authenticated-orcid":false,"given":"Myeong-Cheorl","family":"Kook","sequence":"additional","affiliation":[{"name":"Center for Gastric Cancer, National Cancer Center, Goyang-si 10408, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Young-Woo","family":"Kim","sequence":"additional","affiliation":[{"name":"Center for Gastric Cancer, National Cancer Center, Goyang-si 10408, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keun Won","family":"Ryu","sequence":"additional","affiliation":[{"name":"Center for Gastric Cancer, National Cancer Center, Goyang-si 10408, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,13]]},"reference":[{"key":"ref_1","first-page":"2100","article-title":"Laparoscopic wedge resection of benign gastric tumor","volume":"46","author":"Cheng","year":"1999","journal-title":"Hepato Gastroenterol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"86","DOI":"10.4253\/wjge.v3.i5.86","article-title":"Endoscopic ultrasonography for gastric submucosal lesions","volume":"3","author":"Papanikolaou","year":"2011","journal-title":"World J. Gastrointest. Endosc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"171","DOI":"10.4240\/wjgs.v12.i4.171","article-title":"Clinical course of suspected small gastrointestinal stromal tumors in the stomach","volume":"12","author":"Ye","year":"2020","journal-title":"World J. Gastrointest. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1055\/s-2005-870127","article-title":"Histopathological classification of nonneoplastic and neoplastic gastrointestinal submucosal lesions","volume":"37","author":"Wiech","year":"2005","journal-title":"Endoscopy"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"iii21","DOI":"10.1093\/annonc\/mdu255","article-title":"Gastrointestinal stromal tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"25","author":"Casali","year":"2014","journal-title":"Ann. Oncol."},{"key":"ref_6","first-page":"1223","article-title":"Gastrointestinal stromal tumours (GISTs): French Intergroup Clinical Practice Guidelines for diagnosis, treatments and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO)","volume":"51","author":"Landi","year":"2019","journal-title":"Dig. Liver Dis. Off. J. Ital. Soc. Gastroenterol. Ital. Assoc. Study Liver"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1007\/s00464-006-9065-z","article-title":"Surgical strategy for gastric gastrointestinal stromal tumors: Laparoscopic vs. open resection","volume":"21","author":"Nishimura","year":"2007","journal-title":"Surg. Endosc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.4143\/crt.2016.187","article-title":"Asian Consensus Guidelines for the Diagnosis and Management of Gastrointestinal Stromal Tumor","volume":"48","author":"Koo","year":"2016","journal-title":"Cancer Res. Treat."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1002\/jso.21771","article-title":"Analysis of 151 consecutive gastric submucosal tumors according to tumor location","volume":"104","author":"Lee","year":"2011","journal-title":"J. Surg. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1007\/s11605-014-2708-9","article-title":"Preoperative predictive factors for gastrointestinal stromal tumors: Analysis of 375 surgically resected gastric subepithelial tumors","volume":"19","author":"Min","year":"2015","journal-title":"J. Gastrointest. Surg. Off. J. Soc. Surg. Aliment. Tract"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1007\/s10620-019-05774-5","article-title":"Efficacy of Endoscopic Ultrasound-Guided Fine-Needle Biopsy in Gastric Subepithelial Tumors Located in the Cardia","volume":"65","author":"Kim","year":"2020","journal-title":"Dig. Dis. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1007\/s004640000021","article-title":"Laparoscopic treatment of gastric stromal tumors","volume":"14","author":"Basso","year":"2000","journal-title":"Surg. Endosc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1007\/BF00843462","article-title":"Laparoscopic gastric resection for gastric leiomyoma","volume":"8","author":"Llorente","year":"1994","journal-title":"Surg. Endosc."},{"key":"ref_14","first-page":"117","article-title":"Laparoendoscopic removal of a benign gastric stromal tumor at the cardia","volume":"10","author":"Singaporewalla","year":"2006","journal-title":"JSLS J. Soc. Laparoendosc. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1007\/s004640080158","article-title":"Laparoscopic intragastric stapled resection of gastric submucosal tumors located near the esophagogastric junction","volume":"16","author":"Tagaya","year":"2002","journal-title":"Surg. Endosc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"289","DOI":"10.4174\/astr.2014.86.6.289","article-title":"Higher incidence of gastroesophageal reflux disease after gastric wedge resections of gastric submucosal tumors located close to the gastroesophageal junction","volume":"86","author":"Ko","year":"2014","journal-title":"Ann. Surg. Treat. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1093\/annonc\/mdi127","article-title":"Consensus meeting for the management of gastrointestinal stromal tumors. Report of the GIST Consensus Conference of 20\u201321 March 2004, under the auspices of ESMO","volume":"16","author":"Blay","year":"2005","journal-title":"Ann. Oncol. Off. J. Eur. Soc. Med. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1980","DOI":"10.1007\/s00464-008-9955-3","article-title":"Laparoscopic surgery for submucosal tumors located at the esophagogastric junction and the prepylorus","volume":"23","author":"Hwang","year":"2009","journal-title":"Surg. Endosc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"235","DOI":"10.5946\/ce.2015.096","article-title":"Current Guidelines in the Management of Upper Gastrointestinal Subepithelial Tumors","volume":"49","author":"Cho","year":"2016","journal-title":"Clin. Endosc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.6004\/jnccn.2007.2002","article-title":"NCCN Task Force report: Management of patients with gastrointestinal stromal tumor (GIST)--update of the NCCN clinical practice guidelines","volume":"5","author":"Demetri","year":"2007","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1469","DOI":"10.1007\/s00464-004-8800-6","article-title":"Laparoscopic resection of gastrointestinal mesenchymal tumors located in the upper stomach","volume":"18","author":"Tagaya","year":"2004","journal-title":"Surg. Endosc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1007\/s11605-017-3628-2","article-title":"Short- and Long-Term Outcomes of Endoscope-Assisted Laparoscopic Wedge Resection for Gastric Submucosal Tumors Adjacent to Esophagogastric Junction","volume":"22","author":"Ye","year":"2018","journal-title":"J. Gastrointest. Surg. Off. J. Soc. Surg. Aliment. Tract"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2272","DOI":"10.1007\/s00464-007-9369-7","article-title":"Tailored-approach of laparoscopic wedge resection for treatment of submucosal tumor near the esophagogastric junction","volume":"21","author":"Song","year":"2007","journal-title":"Surg. Endosc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1016\/j.surg.2009.10.035","article-title":"Tailored laparoscopic resection for suspected gastric gastrointestinal stromal tumors","volume":"147","author":"Sasaki","year":"2010","journal-title":"Surgery"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.gie.2020.02.021","article-title":"EUS-guided fine-needle biopsy sampling versus FNA in the diagnosis of subepithelial lesions: A large multicenter study","volume":"92","author":"McCarty","year":"2020","journal-title":"Gastrointest. Endosc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1016\/j.gie.2009.11.044","article-title":"Diagnostic utility of EUS-guided FNA in patients with gastric submucosal tumors","volume":"71","author":"Mekky","year":"2010","journal-title":"Gastrointest. Endosc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.gie.2008.11.038","article-title":"EUS-guided FNA for the diagnosis of GI stromal cell tumors: Sensitivity and cytologic yield","volume":"70","author":"Sepe","year":"2009","journal-title":"Gastrointest. Endosc."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"134","DOI":"10.4103\/EUS-D-20-00171","article-title":"Utility of a 20G needle with a core trap in EUS-guided fine-needle biopsy for gastric submucosal tumors: A multicentric prospective trial","volume":"10","author":"Kamata","year":"2021","journal-title":"Endosc. Ultrasound"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e1622","DOI":"10.1097\/MD.0000000000001622","article-title":"Feasibility and Diagnostic Yield of Endoscopic Ultrasonography-Guided Fine Needle Biopsy with a New Core Biopsy Needle Device in Patients With Gastric Subepithelial Tumors","volume":"94","author":"Lee","year":"2015","journal-title":"Medicine"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"152","DOI":"10.5946\/ce.2015.48.2.152","article-title":"Yields and Utility of Endoscopic Ultrasonography-Guided 19-Gauge Trucut Biopsy versus 22-Gauge Fine Needle Aspiration for Diagnosing Gastric Subepithelial Tumors","volume":"48","author":"Na","year":"2015","journal-title":"Clin. Endosc."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/16\/4733\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:08:12Z","timestamp":1760141292000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/16\/4733"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,13]]},"references-count":30,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["jcm11164733"],"URL":"https:\/\/doi.org\/10.3390\/jcm11164733","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2022,8,13]]}}}