Transvaginal Excision of Rectal Gastrointestinal Stromal Tumor: A Safe Minimally Invasive Approach

<b><i>Introduction:</i></b> Gastrointestinal stromal tumors (GISTs), the specific kit-positive mesenchymal tumors, are rarely found in the anorectum and account for 5% of all GIST cases. Surgical excision remains the main treatment for anorectal GIST. The available techniques include enucleation transanal excision or sometimes an abdominoperineal resection for large or low tumors. <b><i>Case Study:</i></b> We present a middle-aged female with a complaint of intermittent rectal pain for 1 year. Diagnostic workup detected a mass in the rectovaginal septum. A transvaginal excision was performed. Final histopathology showed rectal GIST. On regular follow-up visits, there was no detectable recurrence, and her anal pain disappeared completely. <b><i>Discussion:</i></b> Colorectal GIST accounts for only 0.1% of all colorectal tumors; this infrequency has led to a controversy in its diagnosis and management. Nevertheless, surgery remains a cornerstone element in the management of rectal GISTs. Different resection methods have been described in the literature, ranging from less-invasive approach such as transanal excision to a more radical one like an abdominoperineal resection. As there is no standard approach, choosing which one to perform depends on the tumor size, its location, and the surgeon’s preference. <b><i>Conclusion:</i></b> Transvaginal excision could be considered a safe minimally invasive approach for low-lying rectal GISTs.

Rectal Gastrointestinal Stromal Tumor (GIST): About a Rare and Unusual Case

Rectal gastrointestinal stromal tumors (GIST) are extremely rare, accounting for approximately 0.1% of all rectal tumors. Diagnosis is based on histological and immunohistochemical confirmation. We report the case of a 38-year-old patient with a rectal GIST revealed by chronic rectal bleeding associated with rectal tenesmus, abdominal pain with painful contractions and frequent evacuations evolving in a context of altered general state. Rectoscopy was used to visualize the tumor mass and to take biopsies; their histological and immunohistochemical study revealed a rectal location of a gastrointestinal stromal tumor. The extension assessment was negative. After discussion of the case in a multidisciplinary consultation meeting, management consisted of initially putting the patient on Imatinib given the large tumor size, the degree of local invasion and the location of the mass (lower rectum), with regular follow-up in order to schedule a less invasive surgical resection later. Despite the rarity of rectal GIST, early diagnosis is necessary to avoid progression to locoregional invasion complicating some surgical resections given the anatomical constraints of the pelvic region. Hence the interest of neoadjuvant therapy with tyrosine kinase inhibitors allowing in some cases a decrease in tumor volume, a regression of the degree of local invasion and a decrease in the morbidity of the surgery in order to improve the patient's quality of life.

Neoadjuvant tyrosine kinase inhibitors in rectal gastrointestinal stromal tumours: a provision for enhanced oncological and functional outcomes

Background The role of tyrosine kinase inhibitors (TKI) in the neoadjuvant setting and the optimal duration of therapy remains poorly defined. As such, we aim to evaluate the impact of neoadjuvant TKI on oncological and functional outcomes in our cohort of patients with rectal GISTs. Methods A retrospective analysis of 36 consecutive patients who underwent treatment for rectal GIST at the National Cancer Centre Singapore from February 1996 to October 2017 was analysed. Surgical, recurrence and survival outcomes between the groups who underwent neoadjuvant therapy and those who underwent upfront surgery were compared. Results Patients who received neoadjuvant treatment had significantly larger tumours (median size 7.1 vs. 6.0 cm, p = 0.04) and lower mitotic count (> 10 per 50 HPF, 14 vs. 70%, p = 0.03) when compared with the non-neoadjuvant group. With TKI pre-treatment (median duration 8.8 months), majority of patients (82%) achieved at least partial response to the therapy coupled with a significant downsizing effect of up to 39% (median size of 7.1–3.6 cm), resulting in similar rates of sphincter-sparing surgery (75 vs. 76%, p = 0.94) when compared with the non-neoadjuvant group. In general, neoadjuvant group had lower rates of local recurrence (0 vs. 69%, p = 0.04) and higher overall survival (7.4 vs. 5.7 years, p = 0.03) as compared to the non-neoadjuvant group. Conclusions Neoadjuvant TKI has the benefit of downsizing unresectable rectal GIST to benefit from sphincter-sparing procedure and also confers protection against local recurrence and improves overall survival.

Minimally Invasive Surgery Versus Open Surgery for the Treatment of Rectal Gastrointestinal Stromal Tumor: A Propensity Score Matching Analysis of Short- and Long-Term Outcomes

BackgroundsRectal GISTs are relatively rare and surgical resection is the potential curative treatment for rectal GISTs. However, limited studies addressing the outcomes of minimally invasive surgery for rectal GIST. MethodsA total of 32 rectal GIST patients were retrospective from January 2010 to December 2019 at Xiangya hospital Central South University. The demographic and clinicopathologic data were supplemented by our clinic and pathologic system. Selection bias was eliminated using the propensity score matching (PSM) methods ResultsAfter PSM, 22 patients were finally enrolled in our cohorts, with 11 patients in minimally invasive surgery (MIS) group and 11 patients in open surgery(OPEN) group randomly matched (1:1) by age, gender, body mass index, tumor size, tumor distance above the anal edge. MIS group recived a shorter operating time (108.45±31.56min vs 136.18±28.58min, P=0.043) and lesser blood less(67.27±54.97mL vs 194.55±115.96mL, P=0.004) than OPEN group during the operation. Besides, the MIS group seemed to gain a shorter time to resume borborygmus after operation, flatus passage, resuming oral diet, and hospital stay, but no significantly statistic difference(P＞0.05). Moreover, no differences in rate of 1-year, 3-year, and 5-year Progression Free Survival and overall survival was found between two groups.ConclusionCompared with open surgery, minimally invasive surgery benefits a shorter operating time and lesser blood less in operation in rectal GISTs. Moreover, similar oncologic outcome was found both in minimally invasive surgery and open surgery in rectal GISTs.