Transsacral Approach to Resect a Gastrointestinal Stromal Tumor in the Rectum: Report of Two Cases

Abstract

Gastrointestinal stromal tumors (GISTs) rarely arise in the rectum. Whereas a local resection with negative margins is generally considered adequate for resectable GISTs, a wide resection is usually indicated for rectal lesions because of the technical impossibility of local resection. We report the cases of two patients who underwent resection of a rectal GIST using a transsacral approach. Both patients had an uneventful postoperative course, and no evidence of recurrence has been identified. The transsacral approach appears to be less invasive and should be considered as the treatment of choice for a rectal GIST.

Surgical management of gastrointestinal stromal tumours

“…7). A posterior trans-sacral (Kraske) approach, with wedge resection of the rectum, has some benefits in this setting, including the possibility of obtaining excellent exposure without the need for a major laparotomy, and of avoiding the risk of urogenital dysfunction following total mesorectum excision 79,80 . Similarly, women with GISTs located on the anterior wall of the lower rectum might benefit from a transvaginal approach 81 .…”

Surgical treatment of gastrointestinal stromal tumour of the rectum in the era of imatinib

“…The reported distribution of primary GISTs within the gastrointestinal tract is 50-60 per cent stomach, [25][26][27][28][29][30][31][32][33][34][35] per cent small intestine, 5 per cent colon and rectum, and 1-5 per cent oesophagus 5,6 . GISTs presenting at different sites have differing clinical and pathological features 7 .…”

The Role of Neoadjuvant Imatinib Mesylate Therapy in Sphincter-Preserving Procedures for Anorectal Gastrointestinal Stromal Tumor

“…A transsacral approach has many advantages, including the possibility of obtaining excellent exposure without the need for a major laparotomy, and of avoiding the risk of urogenital dysfunction following total mesorectal excision. 17,18 We regard transsacral procedure as an ideal indication for anorectal GIST.…”