Surgical management of gastric gastrointestinal stromal tumor: A single center experience

Abstract

Background/Aim:Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Surgery remains the mainstay of curative treatment. Our objective is to evaluate the outcome of surgical treatment of primary gastric GIST.Materials and Methods:Between January 1997 and April 2008, thirty seven consecutive patients underwent resection for GISTs (35 patients with primary gastric GISTs and two patients with intestinal GISTs who were excluded from the study). These patients underwent upper endoscopy ± biopsy, barium meal and abdominal CT scan. Patients’ demographics and clinical presentations were analyzed. Perioperative parameters measured included operative times, estimated blood loss, intraoperative finding, surgical techniques, morbidity and length of hospitalization. Recurrence and survival were also analyzed.Results:Of the 35 patients with gastric GISTs included in the study, 63% were female. The median age was 59 ± 14 years (range, 23 to 75 years). The primary presenting symptoms were bleeding and dyspepsia; 43% of these tumors were located mainly in the body of the stomach. Tumor size was < 10 cm in 80% of the patients. The average tumor size was 6.3 ±3.2 cm (range from 3 to 13 cm). Regarding the surgical management, 20 patients (57%) underwent gastric wedge resection, eight patients (23%) underwent partial gastrectomy and the remaining seven patients (20%) underwent total gastrectomy. Radical resections were found in 32 patients (91.5%) while palliative resections were found in three patients (8.5%). The resected lymph nodes were negative in 32 patients (91.5%). Recurrence was noted in three patients, with a median time to recurrence of 14.3 months (range, 7 to 28 months). The three- and five-years survival in patients who underwent wedge resection was 92% and 81%, respectively, where it was 95% and 87%, respectively, in patients who underwent gastrectomy (either partial or total). There were no major intraoperative complications or mortalities.Conclusion:Complete surgical resection either through wedge resection or gastrectomy with negative margins remains the gold standard treatment in the management of patients with primary resectable gastric GISTs.

Wide Surgical Margin Improves the Outcome for Patients with Gastrointestinal Stromal Tumors (GISTs)

“…This subgrouping of R0 and R1 surgery has prognostic significance, and resection margins of 2–3 cm provide good local control [ 11 , 12 ]. Although this classification has not been proven to be applicable for GIST, an extensive surgical technique gave very good results [ 13 ]. In addition, no recurrence was observed during follow-up of 31 patients operated with mainly laparoscopic technique, emphasizing the value of careful resection of all tumors with undamaged peritoneal covering and at least 2 cm margins in site of origin and adherent tissue [ 14 ].…”

Factors Affecting Clinical Outcomes in Women with Non-Gastric Gastrointestinal Stromal Tumors

“…They account for 0.1% to 3% of gastrointestinal malignancies, and the locations ordered by frequency are the stomach (51%), small intestine (36%), colon/rectum (12%), and esophagus (1%) [1]. Surgical resection is the most effective treatment for GIST without metastasis [2,3].…”