Surgical treatment of primary gastrointestinal stromal tumors (GISTs): Management and prognostic role of R1 resections

Abstract

Background: Surgery represents the best treatment for primary gastrointestinal stromal tumors (GISTs). The aim of this study is to analyse outcomes of surgical management in order to evaluate the influence of microscopically R1 margins on survival and recurrence in patients affected by GISTs. Methods: The study reviewed retrospective data from 74 patients surgically treated for primary GISTs without metastasis at diagnosis. Clinical and pathological findings, surgical procedures, information about follow up and outcomes were analyzed. Results: Recurrence rate was low and no patients died in the R1 group during the follow up period. The difference in recurrence free survival for patients undergoing an R0 (n ¼ 54) versus an R1 (n ¼ 20) resections was not statistically significant (76% versus 85% at 3 years, logrank test p-value ¼ 0,14; 63% versus 86% at 5 years, logrank test p-value ¼ 0,48) Conclusions: Microscopically positive margin has no influence on overall and relapse-free survival in GIST patients. Thus, when R0 surgery implies major functional sequelae, it may be decided to accept possible R1 margins, especially for low risk tumors.

The Combination of Neoadjuvant Therapy and Surgical Resection: A Safe and Effective Treatment for Rectal Gastrointestinal Stromal Tumors

“…Recently, several studies that including all GISTs reported that R1 resection did not negatively influence prognosis when excluded tumor rupture. 29–31 In the current study focused on rectal GISTs, we came to a similar result that the recurrence rates of R0 and R1 resection were not significantly different (18.8% vs 20.0%, p=1.000).…”

Neurofibromatosis type 1 associated multiple and cystic gastrointestinal tumors: 02 case reports

“…Surgery is the main treatment for non-metastatic tumors performing a complete R0 resection of the tumor; however a retrospective study (Pantuso & al 2019) highlighted that positive microscopic margins R1 has no influence on the overall survival and the recurrence free survival, hence a R1 surgery can be fulfilling when R0 resection implies major functional consequences [ 10 ]. Since the arrival of tyrosine-kinase inhibitor with imatinib on the head of the list as adjuvant after surgery for moderate and high risk of recurrence or in neoadjuvant for non resectable or metastatic tumors has proven their efficiency with a gain of 13 months of median survival (Otani & al 2006) [ 11 ] and also the emerging of second line (Sunitinib) and third line (Regorafinib) therapies for resistant or intolerant GISTs validated in III phase studies [ 12 , 13 ], in 2014 coreless et al studied 645 patients ; 328 patients assigned to the placebo arm and 317 to the imatinib arm for 74 months concluding that genotype don’t interfere with recurrence free survival (RFS) but the size and site of the tumor along with mitotic rate influenced the RFS ; especially patients with KIT exon 11 deletion had a longer RFS after 1 year of imatinib [ 14 ].…”

Combined endo-laparoscopic treatment of large gastrointestinal stromal tumor of the stomach: Report of a case and literature review

“…Complete resection with microscopic negative margins (R0) and integrity of pseudocapsule is the main objective of surgery. Sometimes the achievement of disease-free resection margins requires major functional results, and in those cases it may be decided to perform a lesser aggressive surgical resection without obtaining negative margins in low-risk lesions [ 20 ]. Lymph nodes dissection is not recommended except when metastasis are clinically suspected.…”