Analysis of risk factors for postoperative delayed perforation following endoscopic submucosal dissection in the treatment of gastrointestinal stromal tumors

Objective We aimed to identify independent risk factors for delayed perforation following endoscopic submucosal dissection (ESD) in gastrointestinal stromal tumors (GISTs). Methods This study was a retrospective case-control study that included 113 patients with GIST who underwent ESD treatment. Among them, 13 patients who developed postoperative delayed perforation constituted the perforation group, while 100 patients without such a complication formed the control group. The differences in demographics, clinical characteristics, and surgical details between the two groups were analyzed and compared. Independent risk factors for delayed perforation were identified through univariate and multivariate logistic regression analyses. Meanwhile, the occurrence time, management, and outcomes in the perforation group were recorded, and the postoperative gastrointestinal function recovery times of the two groups were compared. Results Univariate analysis revealed significant differences between the perforation and control groups in four factors: tumor diameter, growth pattern, degree of submucosal fibrosis, and intraoperative muscular layer injury ( p  < 0.05). Multivariate logistic regression analysis confirmed that tumor diameter > 2.0 cm, extraluminal growth, severe submucosal fibrosis, and intraoperative muscular layer injury were independent risk factors for delayed perforation after ESD ( p  < 0.05). Kaplan-Meier analysis showed that the median time to diagnosis of delayed perforation in the 13 patients was 10 hours postoperatively, with the majority of perforations occurring within 24 hours postoperatively. The median hospital stay in the perforation group (16 days) was longer than that in the control group (7.5 days). After treatment, the first flatus time, first oral intake time, and first bowel movement time were longer in the perforation group than in the control group ( p  < 0.05). Conclusion Tumor diameter > 2.0 cm, extraluminal growth, severe submucosal fibrosis, and intraoperative muscular layer injury are independent risk factors for delayed perforation after ESD in the treatment of GISTs. Perforations predominantly occur within 24 hours postoperatively, necessitating enhanced postoperative monitoring in high-risk patients.