Patterns of recurrence after resection of rectal gastrointestinal stromal tumors and the effect of adjuvant therapy.

531 Background: Since gastrointestinal stromal tumors (GISTs) of the rectum are rare, clinical features and treatment outcome have not been well documented. Methods: Data from patients with rectal GIST diagnosed and primarily treated between 2003-2007 at 17 institutions in Japan were collected and analyzed on clinical characteristics, pathologic features and recurrence patterns. Results: Twenty-five patients (11 men and 14 women) with rectal GISTs were collected. Median age was 67years old. Pathological examinations disclosed that the median number of mitoses and the size of tumors were 4 counts/50HPF and 4.5cm, respectively. By the Miettinen criteria, 44 percent (n = 11) were classified as high-risk, 32 percent (n = 8) as low-risk and 16 percent (n = 4) as none-risk gastrointestinal stromal tumors. Sixty-three percent (7/11) of patients with high-risk GISTs had developed recurrence. None of patients (n = 12) with low or none-risk gastrointestinal stromal tumors have recurred after a median follow-up of 1699 (range, 135-3871) days. 85 percent (6/7) of recurrent patients showed loco-regional recurrence. Twelve patients with rectal GISTs received local excision and thirteen patients received extended resection (abdominoperineal resection or low anterior resection). Loco-regional recurrence rate following local excision was 25% (3/12), which was similar with that of extended resection (23%, 3/13).7 patients received neoadjuvant and/or adjuvant imatinib. Only one patient of 7 patients who received perioperative imatinib treatment developed recurrence. Conclusions: Loco-regional recurrence was the most predominant pattern of recurrence after surgical resection of rectal GISTs. The Miettinen criteria were useful to differentiate the high risk group. Recurrence rate was lower in patients treated with perioperative imatinib. Rectal GIST may be optimally managed by perioperative multimodal treatment instead of extending surgical resection.

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Gastrointestinal stromal tumor of rectum

Journal of Surgical Sciences ◽

10.3329/jss.v19i2.44006 ◽

2019 ◽

Vol 19 (2) ◽

pp. 85-88

Author(s):

Md Rayhanur Rahman ◽

Md Shahadot Hossain Sheikh ◽

Ismat Jahan Lima ◽

Most Bilkis Fatema ◽

Md Ariful Alam ◽

...

Keyword(s):

Gastrointestinal Tract ◽

High Risk ◽

Gastrointestinal Stromal Tumor ◽

Surgical Resection ◽

Gastrointestinal Stromal Tumors ◽

Stromal Tumor ◽

Intermediate Risk ◽

Stromal Tumors ◽

Rectal Gist ◽

Complete Surgical Resection

Although gastrointestinal stromal tumors (GISTs) frequently occur in the gastrointestinal tract, they are relatively rare in the rectum. Biopsy of the lesion and immunohistochemistry (IHC) confirm the diagnosis. Complete surgical resection is the principal curative procedure. In combination with surgery, immunotherapy with Imatinib shows cure in intermediate risk and improvement in high risk rectal GIST. We report a case of a 45-yearold female who presented with constipation and generalized weakness, ultimately diagnosed to have rectal GIST. Journal of Surgical Sciences (2015) Vol. 19 (2) : 85-88

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Surgical Approaches and Oncological Outcomes in the Management of Duodenal Gastrointestinal Stromal Tumors (GIST)

Journal of Clinical Medicine ◽

10.3390/jcm10194459 ◽

2021 ◽

Vol 10 (19) ◽

pp. 4459

Author(s):

Nikolaos Vassos ◽

Aristotelis Perrakis ◽

Werner Hohenberger ◽

Roland S. Croner

Keyword(s):

High Risk ◽

Surgical Approach ◽

Tumor Size ◽

Gastrointestinal Stromal Tumors ◽

Tumor Biology ◽

Disease Free Survival ◽

Extended Resection ◽

Stromal Tumors ◽

Duodenal Gist ◽

Increased Risk

Background: Duodenal gastrointestinal stromal tumors (GIST) are a rare subset of GIST. Their surgical management in this anatomically complex region consists of varied approaches, and the administration of imatinib mesylate (IM) has not been clarified. Methods: We retrospectively reviewed patients with duodenal GIST treated during a 10-year-period. We analysed the clinicopathological characteristics and survival factors and evaluated the perioperative and long-term outcomes based on the extent of resection ((ocal-resection (LR) versus pancreaticoduodenectomy (PD)) and the IM-administration. The median follow-up period was 60 months (range, 12–140). Results: A total of thirteen patients (M:F = 7:6) with median age of 64 years (range, 42–77) underwent resection of duodenal GIST. Median tumor size was 5.2 cm (range, 1.5–13.3). Eight patients (61.5%) underwent LR and five patients (38.5%) PD. R0-resection was achieved in 92.5%. Neoadjuvant IM-therapy was administered in five patients leading to tumor downsizing and in 40% to less-extended resection. The PD group consisted of larger tumors with higher mitotic count, mostly located in D2 (p = 0.031). The PD group had longer operative time (p = 0.026), longer hospital stay (p = 0.016), and higher rate of postoperative complications (p = 0.128). The actuarial 1-, 3-, and 5-year overall survival were 92.5%, 84%, and 73.5%, respectively, whereas the disease-free survival rates at 1, 3, and 5 years were 91.5%, 83%, and 72%, respectively. A tendency towards increased risk of disease recurrence was demonstrated for patients with tumor >5 cm and high-risk potential. There was not statistic survival benefit for one or the other surgical approach. Conclusion: The type of resection depends on duodenal site of origin and tumor size. LR can be the treatment of choice for duodenal GIST whenever technically feasible. Recurrence of duodenal GIST is dependent on tumor biology rather than surgical approach. Administration of IM in neaodjuvant setting should be considered in cases with high-risk GIST scheduled for PD since it might facilitate less-extended resection.

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