Are We Allowed to Limit Surgical Aggressiveness With Small Rectal Gastrointestinal Stromal Tumors?

Fiore, Marco; Raut, Chandrajit P.; Gronchi, Alessandro

doi:10.1245/s10434-016-5710-5

Cited by 4 publications

(3 citation statements)

References 7 publications

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“…Surgical resection is the principle treatment for GISTs [7] , but larger tumors are more difficult to resect completely and have a higher risk of local recurrence because of intraoperative capsule damage. Treating rectal GISTs is particularly difficult because of the anatomical constraints of the pelvis, which hinder manipulation and preserve anal function [8] , [9] . In particular, there have been no reports on GISTs wherein anal function was preserved because of suspected external anal sphincter invasion, as in this case.…”

Section: Discussionmentioning

confidence: 99%

Transanal approach after preoperative imatinib treatment of a rectal gastrointestinal stromal tumors with external anal sphincter invasion: A case report

Hisanaga

Nosanaka

Miyata

et al. 2021

International Journal of Surgery Case Reports

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Introduction and importance Rectal gastrointestinal stromal tumors (GISTs) are rare, and preserving anorectal function can be challenging. We report the case of a patient with rectal GIST with external anal sphincter invasion, treated via the laparoscopic and transanal approaches. Case presentation A 61-year-old man with locally advanced GIST in the right anterolateral wall of the lower rectum was examined. Lower endoscopy revealed a 50-mm submucosal tumor located 4 cm from the anal verge. On immunohistochemistry, the biopsy specimen tested positive for CD34 and C-KIT, and the patient was diagnosed with GIST. Abdominal magnetic resonance imaging (MRI) revealed external anal sphincter infiltration. Because of the large tumor size and proximity to the anal verge, preserving the anus was challenging, and colorectal resection was avoided. Instead, neoadjuvant therapy with imatinib was administered to facilitate local resection of the tumor. Post-treatment MRI showed a reduction in tumor size (30 × 20 × 30 mm), and surgery was performed. We identified an appropriate resection line for diplomatic sphincter resection of the infiltrated area by laparoscopy alone. Thus, we performed a hybrid surgery using the laparoscopic and transanal approaches. The patient had an unremarkable postoperative course and was discharged on postoperative day 23. Clinical discussion No study has reported cases of rectal GIST with external anal sphincter invasion wherein anal function was preserved. Here, imatinib was administered preoperatively, and hybrid surgery was performed using the transanal and laparoscopic approaches. Conclusion Preoperative treatment and surgery preserved anorectal function in a patient with a massive rectal GIST.

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Section: Discussionmentioning

confidence: 99%

Transanal approach after preoperative imatinib treatment of a rectal gastrointestinal stromal tumors with external anal sphincter invasion: A case report

Hisanaga

Nosanaka

Miyata

et al. 2021

International Journal of Surgery Case Reports

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“…It is an interesting subgroup of the GISTs, because of their large size and the proximity to the anal sphincter. Due to their location, abdominoperineal resection, with possible complications such as sexual or urological dysfunctions,14 is sometimes unavoidable. Therefore, neoadjuvant treatment with tyrosine kinase inhibitors may be necessary in order to achieve local complete resection with anus preservation, as in the case we present.…”

Section: Discussionmentioning

confidence: 99%

<p>Management of low rectal gastrointestinal stromal tumor with neoadjuvant therapy and transanal excision: a rare case report and review of the literature</p>

Kosmidis¹,

Sapalidis²,

Tsakalidis³

et al. 2019

IJGM

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Background Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. However, rectal GISTs represent only 5% of this category. We report a case of a rectal GIST treated with local excision after neoadjuvant therapy. Case presentation A 41-year-old male patient presented with anal bleeding. Colonoscopy revealed a mass located 5 cm from the anal verge. Histological examination showed a GIST with immunohistochemical positivity for CD117 and CD34. Transanal local excision was performed after neoadjuvant therapy. Conclusion Neoadjuvant immunotherapy for GISTs with unfavorable localization may facilitate local excision and avoid complications of more demanding operations.

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“…The aim is to do the lesion excision (R0 resection), without violating the lesion itself. In the low rectum, there must be taken account the proximity of the anal sphincters, with risks of complications like anal incontinence or sexual or urological dysfunction in more extensive resections [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Transvaginal Resection of a Rectal Gastrointestinal Stromal Tumor: A Case Report

et al. 2021

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Gastrointestinal stromal tumors (GISTs) are a type of mesenchymal tumors. They are rare in rectum. This location is a surgical challenge due to the high morbidity after aggressive surgeries. We present the case of an 81-year-old female with a high-grade GIST treated with transvaginal excision and adjunctive therapy with imatinib. The postoperative period was uneventful without anal dysfunction. Within the types of surgical treatment available, transvaginal excision is an acceptable procedure in lesions located in the rectovaginal region.

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Are We Allowed to Limit Surgical Aggressiveness With Small Rectal Gastrointestinal Stromal Tumors?

Cited by 4 publications

References 7 publications

Transanal approach after preoperative imatinib treatment of a rectal gastrointestinal stromal tumors with external anal sphincter invasion: A case report

Transanal approach after preoperative imatinib treatment of a rectal gastrointestinal stromal tumors with external anal sphincter invasion: A case report

<p>Management of low rectal gastrointestinal stromal tumor with neoadjuvant therapy and transanal excision: a rare case report and review of the literature</p>

Transvaginal Resection of a Rectal Gastrointestinal Stromal Tumor: A Case Report

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