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Background:  The established criteria for determining whether to excise the cardia during laparoscopic surgery for gastrointestinal stromal tumors in the esophagogastric junction (EGJ-GISTs) remain controversial. This retrospective multicenter study was conducted to develop a nomogram for predicting the risk of the cardia excision during laparoscopic surgery for EGJ-GISTs.   Material and Methods:  We reviewed data from 2,127 gastric-GISTs (g-GISTs) patients without distant metastases in four hospital between June 2012 and June 2020. Of those, according to the including criteria, 184 patients [Guangdong Provincial Hospital of Chinese Medicine ( n  = 81), Nanfang Hospital of Southern Medical University ( n  = 60), Guangdong General Hospital ( n  = 34), and The Third Affiliated Hospital of Southern Medical University ( n  = 9)] with EGJ-GISTs were identified and included in this study. Factors contributing to risk of cardia excision were identified and used to create a nomogram. Nomogram performance was assessed using a bootstrapped concordance index (c-index) and calibration plots.   Results:  According to the multivariate analysis, the distance from the margin of the tumor to the esophagogastric line (EG-line) (cm) ( OR  = 0.001,  95% CI : 0.00001~0.056,  P  = 0.001) and tumor size (cm) ( OR  = 14.969,  95% CI : 1.876~119.410,  P  = 0.011) were significantly related to likelihood of cardia structure excision in laparoscopic surgery for EGJ-GISTs. These two factors were used to generate a nomogram for predicting risk of cardia excision using a logistic regression model; a bootstrapped  C-index  of 0.988 (calibrated  C-index  = 0.987) indicated strong predictive ability, with broad calibration.   Conclusions:  This nomogram based on distance from tumor margin to EG-line and tumor size may serve as a tool for predicting risk of cardia damage during laparoscopic removal of EGJ-GISTs to aid in selection of surgical methods and preoperative neoadjuvant therapy.

frontiers in surgery

Nomogram for Predicting Risk of Esophagogastric Junction (EGJ) Resection During Laparoscopic Resection of Gastrointestinal Stromal Tumors in EGJ: A Retrospective Multicenter Study