Minimally invasive approaches to small gastric stromal tumors: The less with the more

In this paper, we comment on the article by Gu et al published in 2024, investigating whether there were differences in the clinical/perioperative outcomes of endoscopic and laparoscopic resections of gastric stromal tumors. Compared with most carcinomas, gastrointestinal stromal tumors are quite common worldwide and have a better prognosis. However, they respond to specific chemotherapies and do not routinely require standard lymphadenectomy. The gastric origin is known to be the most represented. Survival after proven radical surgery is excellent, with recurrences being extremely infrequent. Currently, induction/perioperative chemotherapy for high-risk tumors larger than 5 cm can downstage neoplasia and maintain good survival. Therefore, the standard of care for nonmetastatic, resectable tumors is surgical excision (avoiding formal lymphadenectomy) with or without chemotherapy. In the case of small- (2 cm) to medium- (5 cm) sized tumors, minimally invasive surgical approaches (laparoscopic or robotic) have been advocated, and more recently, a purely endoscopic technique has also been proposed. All these interventions are feasible and effective, although no definitive results have been published to prove the superiority of one over another; however, further investigation of its associated oncologic outcomes is still needed. Unfortunately, rigorous, prospective, randomized controlled trials are challenging to conduct, develop, and receive ethical approval for, whereas the final decision of the surgical route is often related to the availability of instrumentation and local expertise.