Is nonanatomic rectal resection a valid therapeutic option for rectal gastrointestinal stromal tumors? A proposed decision algorithm

Abstract

Background and objectives: The best surgical approach to rectal gastrointestinal stromal tumors (GISTs) is still debated, and both nonanatomic rectal resection (NARR) and anatomic rectal resection (ARR) are applied. The aim of this study was to evaluate the feasibility and oncological outcomes of NARR and ARR for rectal GISTs (R-GISTs). Methods: Through a large French multicentre retrospective study, 35 patients were treated for R-GIST between 2001 and 2013. Patients who underwent NARR and ARR were compared. Results: There were 23 (65.7%) patients in group ARR and 12 (34.3%) in group NARR. Significantly more patients in the group with ARR had a neoadjuvant treatment (86%) with tyrosine kinase inhibitor (TKI) (imatinib) compared to those with NARR (25%) (p < .01). The median preoperative tumor size was significantly different between the groups without and with neoadjuvant TKI: 30 ± 23 mm versus 64 ± 44.4 mm, respectively (p < .001). Overall postoperative morbidity was 20% (n = 7) (26% for ARR vs. 8% for NARR; p = .4). After a median follow-up of 60.2 (3.2-164.3) months, the 5-year disease-free survival rates were 79.5% (confidence interval [CI] 95%: 54-100) for the NARR group and 68% (CI 95%: 46.4-89.7) for the ARR group (p = .697), respectively. Conclusion: The use of NARR for small R-GIST's does not seem to impair the oncological prognosis.

A systematic review and meta‐analysis of neoadjuvant imatinib use in locally advanced and metastatic gastrointestinal stromal tumors

“…Thrity five studies were ultimately included for final analysis 6 ,. 12 , 13–46 An additional study meeting the inclusion criteria was identified from citation searching, 47 bringing the total number of final included articles to 36. The PRISMA flow diagram (Figure 1) outlines the study selection process and details the rationale for study exclusion.…”

Local excision and radical excision for rectal gastrointestinal stromal tumors: a meta-analysis protocol

“…To date, several studies have compared the surgical and oncological outcomes of LE and RE for rectal GISTs (11)(12)(13)(14), but some have limited numbers of small series. This study aims to systematically review available literature to compare the impact of LE and RE in localized rectal GIST patients on R0 resection, operation duration, length of stay, recurrence, and survival.…”

Needle tract seeding and abdominal recurrence following pre-treatment biopsy of gastrointestinal stromal tumors (GIST): results of a systematic review

“…Multimodal treatment of these tumors is different and surgical strategies vary in those patients who require resection (e.g., lymphadenectomy, e.g., dimension of resection margins etc.) [ 23 – 25 ].…”