Preoperative Chemotherapy and Survival for Large Anorectal Gastrointestinal Stromal Tumors: A National Analysis of 333 Cases

Abstract

Size is the most important determinant in survival following resection. Local excision is common, with resection split between LR and RE. For smaller tumors, LR may be adequate therapy. Preoperative chemotherapy may result in improved survival for large tumors treated with radical resection, but the data are imperfect.

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

“…1 This is the largest series of anorectal GISTs reported to date, obtained from the National Cancer Data Base (NCDB), which includes more than 1500 centers in the United States.…”

“…Concerning the surgical approach, Hawkins et al 1 distinguished between anorectal GISTs treated with radical excision and those treated with local resection, concluding that local resection is acceptable, with no difference in survival compared with radical excision for tumors smaller than 5 cm. Indeed, the equipoise between conservative and extended surgical resection of GISTs (any site) has been debated because an effective cytoreductive therapy by tyrosin-kinase inhibitors (TKIs) became available during the last 15 years.…”

“…2 To date, reported data on rectal GISTs have been limited to small retrospective series of patients undergoing surgery at referral centers and to the few patients included in the adjuvant prospective randomized studies (10 patients in the ACOSOG Z9001 study, 35 patients in the SSG/AIO study, and an unknown number of patients in the EORTC-STSBG study). [3][4][5] However, due to the nature of the NCDB, the analysis of Hawkins et al 1 has several shortcomings. First, only overall survival (OS) is available.…”

“…In the era of TKIs, which significantly prolong OS upon recurrence, mediumterm OS may not reflect the real impact on the disease control of the initial strategy. Therefore, the analysis of Hawkins et al 1 on the role of local resection versus radical excision should be cautiously interpreted concerning the impact of surgical technique on local recurrence.…”

“…Despite these limitations, the study by Hawkins et al 1 still provides important additional knowledge to the community. In general, patients affected by rare disease such as rectal GISTs should be treated at referral centers by a team of experienced clinicians, essentially due to the multidisciplinary approach this disease may often require.…”