Experience of Surgical Management of Gastrointestinal Stromal Tumors at a Tertiary Hospital of Nepal

Abstract

Gastrointestinal stromal tumors (GISTs) are rare malignancies but a most common mesenchymal tumor. A multidisciplinary team approach is the optimal care of GIST patients after the remarkable outcomes with the development of molecular-targeted therapy. The objective is to determine the clinic-pathological spectrum and risk category of GIST along with perioperative outcomes. This is a retrospective review of GIST patients between September 2015-August 2018 at Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal. Patients' clinical data, histopathology, immunohistochemistry (IHC) and outcomes were recorded and analyzed. A total of 42 GIST patients were identified with age (19-81 years) and 69% were males. Stomach (35.7%) was the most common site followed by small bowel (23.8%) and duodenum (14.3%). Pain (40.5%) followed by bleeding (30.9%) were major indications. Max tumor dimensions were ranging from 2.8-30 cm and median mitotic figures were 3 (0-35). Patients were stratified as high, intermediate, low and very low risk (36%, 32%, 32%, and 0% respectively). The majority were managed surgically out of which three cases underwent preoperative angioembolization. CD 117 was positive in 90.5%. Neoadjuvant imatinib given in 2 cases while adjuvant imatinib given in 18 cases. Over a median follow up of 18 months four patients expired while 32 had no issues. Surgical resection is the preferred choice of treatment with or without the molecular targeted drug therapy. Most tumors fall in the high-risk category.