Is the Surgical Margin in Gastrointestinal Stromal Tumors Different

Rutkowski, Piotr; Skoczylas, Jacek; Wisniewski, Piotr

doi:10.1159/000491649

Cited by 12 publications

(16 citation statements)

References 45 publications

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“…Based on the imaging data, removal of the residual tumor was indicated when the maximum therapeutic response was reached (no further reduction in tumor diameters in consecutive imagings of 3 months) or when no further influence on the resectional strategy was expected. A margin of safety of 1 cm was considered enough to spare organ function [ 28 ]. The type of surgery was classified according to EORTC STBSG classification: local excision (wedge resection), limited resection (partial resection of the stomach), typical organ resection (total gastrectomy) and multivisceral resection (including adjacent organs) or other (with verbal specification) [ 29 ].…”

Section: Methodsmentioning

confidence: 99%

Preservation of Organ Function in Locally Advanced Non-Metastatic Gastrointestinal Stromal Tumors (GIST) of the Stomach by Neoadjuvant Imatinib Therapy

Vassos

Jakob

Kähler

et al. 2021

Cancers

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Background: Neoadjuvant imatinib mesylate (IM) for advanced, non-metastatic gastrointestinal stromal tumors (GIST) of stomach is recommended to downsize the tumor prompting less-extensive operations and preservation of organ function. Methods: We analyzed the clinical-histopathological profile and oncological outcome of 55 patients (median age 58.2 years; range, 30–86 years) with biopsy-proven, cM0, gastric GIST who underwent IM therapy followed by surgery with a median follow-up of 82 months. Results: Initial median tumor size was 113 mm (range, 65–330 mm) and 10 patients started with acute upper GI bleeding. After a median 10 months (range, 2–21 months) of treatment, tumor size had shrunk to 62 mm (range, 22–200 mm). According to Response Evaluation Criteria In Solid Tumors version 1.0 and version 1.1 (RECIST 1.1), 39 (75%) patients had partial response and 14 patients had stable disease, with no progressive disease. At plateau response, 50 patients underwent surgery with an R0 resection rate of 94% and pathological complete response in 24%. In 12 cases (24%), downstaging allowed laparoscopic resection. The mean recurrence-free survival (RFS) was 123 months (95%CI; 99–147) and the estimated 5-year RFS was 84%. Conclusions: Neoadjuvant IM allowed stomach preservation in 96% of our patients with excellent long-term RFS, even when starting treatment during an episode of upper GI bleeding. Preservation of the stomach provides the physiological basis for the use of oral IM in the adjuvant or metastatic setting.

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Section: Methodsmentioning

confidence: 99%

Preservation of Organ Function in Locally Advanced Non-Metastatic Gastrointestinal Stromal Tumors (GIST) of the Stomach by Neoadjuvant Imatinib Therapy

Vassos

Jakob

Kähler

et al. 2021

Cancers

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“…Factors influencing the choice of resection technique include lesion size, lesion type, and location [ 5 ]. The National Comprehensive Cancer Network Guidelines suggest resection of all tumours over 2 cm in diameter or in the case of malignancy suspicion and/or progression during the follow-up period, regardless of the tumour size [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…According to the latest recommendations of the European Society for Medical Oncology, the management of GISTs should include wide excision with confirmed tumour-free margins (R0) as the principal treatment goal for resectable tumours, as it minimises the Medicina 2021, 57, 2 of 10 recurrence rate [4][5][6]. Intra-procedural complications, such as tumour ruptures and perforations, also negatively affect prognosis [6].…”

Section: Introductionmentioning

confidence: 99%

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On the Track of New Endoscopic Alternatives for the Treatment of Selected Gastric GISTs—A Pilot Study

Raiter¹,

Pawlak

Kozłowska-Petriczko

et al. 2021

Medicina

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Background and Objectives: GISTs (Gastrointestinal stromal tumors) are the most common mesenchymal gastrointestinal tract tumours and are mainly located in the stomach. Their malignant potential depends on size, location, and type. Endoscopic techniques are a less invasive modality for patients not eligible for surgery. ESD (endoscopic submucosal dissection) is mainly used for the removal of smaller GISTs, with intraluminal growth and a more superficial location. Thus, R0 resection capability in some cases may be not sufficient, limited by tumour size, location in the gastric wall, and its connection level with the muscularis propria. In such cases, an endoscopic full-thickness resection can become a new alternative. In this retrospective pilot study, we evaluated ESD and hybrid resection techniques in terms of safety, efficacy, and disease recurrence for selected types of gastric GISTs. Materials and Methods: A retrospective comparison was conducted in a group of patients who underwent ESD or a hybrid technique combining endoscopic resection with endoscopic suturing using the OverStitch system (HT) for type II or III gastric GISTs. A total of 21 patients aged 70 ± 8 years underwent endoscopic resection. Seventeen lesions were treated with ESD and four with the HT. Results: R0 resection was achieved in all patients treated using HT (type III lesions) and in 53% of those treated with ESD (p = 0.08). None of the type III lesions treated with ESD were excised with R0. Lesions treated with R0 ESD resections were significantly smaller (1.76 ± 0.35 cm) than those with R1 ESD resections (2.39 ± 0.40 cm) (p < 0.01). The mean lesion size treated with the HT was 2.88 ± 0.85 cm. Conclusions: HT may be a new resection modality for large gastric GISTs with high muscularis propria connection grades. Further studies are required to evaluate its safety and efficacy and to form precise inclusion criteria for endoscopic resection techniques.

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“…Rutkowski et al [6] address the question of surgical margins in resections for GIST, particularly taking into account the fact that the tumors are sometimes very fragile, are well-perfused, and might easily shed tumor cells to the peritoneal cavity. They also discuss the question on whether R1 resections require a second surgical procedure to achieve negative margins, as in the case for extremity sarcomas.…”

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confidence: 99%