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.

Clinicopathological features, clinical efficacy on 101 cases of rectal gastrointestinal stromal tumors, and the significance of neoadjuvant therapy

Objective To investigate the clinicopathological features and clinical efficacy among 101 cases of rectal gastrointestinal stromal tumors (GISTs) and to investigate the significance of imatinib mesylate (IM) neoadjuvant therapy. Methods The clinicopathological features, treatment methods, perioperative data, and prognosis of the patients were summarized and analysed in 101 patients with rectal GISTs who received treatment in the Gastrointestinal Surgery of West China Hospital of Sichuan University and the Affiliated Hospital of Guizhou Medical University from August 2002 to November 2020 in China. Results A total of 101 patients, including 64 males and 37 females, were aged from 22 to 79 years (55.4 ± 12.2 years). Among the 70 patients who underwent direct surgery, 8 were very low risk cases, 10 were low risk cases, 7 were intermediate risk cases, and 45 were high risk cases. Cox regression analysis showed that postoperative IM adjuvant treatment improved the disease-free survival (DFS) and overall survival (OS) of 52 intermediate and high risk patients. Among the 31 patients who received neoadjuvant therapy, the objective response rate (ORR) was 83.9% (26/31), and the disease control rate (DCR) reached 96.8% (30/31). Subgroup analysis was also conducted based on the tumour diameter. (1) Among the 36 patients with a diameter ≤ 5 cm, two patients received IM neoadjuvant therapy, while 34 patients received direct surgery. Neither univariate nor Cox regression analysis found that neoadjuvant therapy affected DFS and OS. (2) Among the 65 patients with a diameter > 5 cm, 29 received IM neoadjuvant therapy, and 36 received direct surgery. Patients who underwent neoadjuvant therapy had less blood loss (P = 0.022), shorter postoperative hospital stay (P = 0.001), increased anal retention rate (93.1% vs. 72.2%, P = 0.031), and decreased enterostomy rate (10.3% vs. 33.3%, P = 0.037) than those who underwent direct surgery. Cox regression analysis suggested that neoadjuvant therapy and postoperative IM adjuvant therapy improved DFS. Conclusion Rectal GISTs are relatively rare and highly malignant tumors. Postoperative oral IM therapy can improve the DFS and OS of intermediate and high risk patients. In patients with rectal GISTs with diameters > 5 cm, IM neoadjuvant therapy can improve anal retention rate, preserve the structure and function of the organs, reduce enterostomy rate, and improve prognosis.

Clinicopathological Features, Clinical Efficacy on 101 Cases of Rectal Gastrointestinal Stromal Tumors, and the Significance of Neoadjuvant Therapy

Objective: To investigate the clinicopathological features, clinical efficacy on 101 cases of rectal gastrointestinal stromal tumors (GISTs), and the significance of Imatinib Mesylate (IM) neoadjuvant therapy.Methods: The clinicopathological features, treatment methods, peri-operative data, and prognosis of the patients were summarized and analyzed on 101 patients with rectal GISTs, who received treatment in the Gastrointestinal Department of West China Hospital of SichuanUniversity and the Affiliated Hospital of Guizhou Medical University from August 2002 toNovember 2020 in China. Results: A total of 101 patients, including 64 males and 37 females, were aged from 22 to 79 years (55.4±12.2 years). Among 70 patients with direct surgery, which included 8 very low risk cases, 10 low risk cases, 7 intermediate risk cases, and 45 high risk cases. Cox regression analysis showed that post-operative IM adjuvant treatment improved disease-free survival (DFS) and overall survival (OS) of 52 intermediate and high risk patients. Among the 31 patients who received neoadjuvant therapy, the objective response rate (ORR) was 83.9% (26/31), and the disease control rate (DCR) reached 96.8% (30/31). Diameter subgroup analysis: (1) Among the 36 patients with a diameter ≤ 5 cm, two patients received IM neoadjuvant therapy, while 34 patients received direct surgery. Both univariate and Cox regression analysis did not find that neoadjuvant therapy affects DFS and OS. (2) Among the 65 patients of diameter >5 cm, 29 received IM neoadjuvant therapy and 36 received direct surgery. Patients who underwent neoadjuvant therapy had less blood loss (P=0.022) , shorter post-operative hospital stay (P=0.001), increased anal preservation proportion (93.1% VS72.2% , P=0.031), decreased enterostomy proportion (10.3% VS 33.3%, P=0.037) than those who underwent direct surgery. Cox regression analysis suggested that neoadjuvant therapy and post-operative IM adjuvant therapy improved DFS. Conclusion: Rectal GISTs is relatively rare and is a highly malignant tumor, post-operative oral IM therapy can improve DFS and OS of intermediate and high risk patients. In patients with rectal GISTs with diameter > 5 cm, IM neoadjuvant therapy can improve the anal preservation proportion , preserve the structure and function of the organs, reduce enterostomy proportion, and improve prognosis.

Clinicopathologic Characteristics and Treatment Outcomes of Rectal Gastrointestinal Stromal Tumors: A Retrospective Study

Background and Study Aims: To investigate the clinicopathologic characteristics, surgical and imatinib management and long-term follow-up outcomes of the rectal gastrointestinal stromal tumors (GISTs). Patients and Methods: Consecutive patients with rectal GISTs admitted to our center (from January 2013 to June 2018) were chosen. Their history information was viewed, and the follow-up results were obtained by phone or medical records. Results: Forty-nine patients (32 males and 17 females) were identified, with a median age of 59 years, and 36 patients received surgery. Most (46 patients, 93.9%) of the tumor were located within 6 cm from the anal verge, 18 patients (36.7%) had very low or low risk, and 31 patients (63.3%) had intermediate or high risk. Four kinds of surgery approach were applied in our center: trans-abdominal (8 patients, 22.2%), trans-anal/trans-perineal (15 patients, 41.7%), trans-sacral (12 patients, 33.3%) and abdominoperineal (1 patient, 2.8%). The complication is low and the mortality related to surgery is 0%. After a median follow-up of 705 days (ranged from 48 days to 1677 days), 3 patients (8.33%) were found to have a recurrence. Conclusion: Trans-anal/trans-perineal and trans-sacral surgery were more commonly used in our study, and for now, the recurrence rate had no difference, but a longer time for follow-up is needed.

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.

Transvaginal excision of rectal stromal tumors: case reports and a literature review

Background Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Rectal locations are very rare, and minimally invasive surgery is a good choice for the treatment of rectal GISTs. Case presentation Two women each had a mass located on the lower vaginal-rectal space as determined by transvaginal ultrasound (TV-US), pelvis MR imaging, and colonoscopy. The patients successfully underwent transvaginal excision. The spindle-shaped cells were found in pathological test. The immunohistochemical analysis showed that CD117 and Dog-1 were stained positively. These results confirmed the masses as GISTs. The postoperative period was uneventful without anal dysfunction. Two patients were received adjuvant treatment with imatinib after surgery. Conclusion Transvaginal excision could be a minimally invasive and safe alternative treatment in the management of rectal GISTs in lower locations.

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.