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Surgical Endoscopy

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01-07-2021 | Gastrointestinal Stromal Tumor

Transanal endoscopic microsurgery with alternative neoadjuvant imatinib for localized rectal gastrointestinal stromal tumor: a single center experience with long-term surveillance

Authors: Xueshan Bai, Weixun Zhou, Yunhao Li, Guole Lin

Published in: Surgical Endoscopy | Issue 7/2021

Abstract

Background

Transanal endoscopic microsurgery (TEM) is widely used in the treatment of local rectal lesions and helps avoid radical surgery. This study evaluated the management and outcome in a long-term followed cohort of patients with localized rectal GIST underwent TEM with alternative neodajuvant imatinib (nIM).

Methods

A retrospective cohort study was undertaken of patients identified from a case database at Department of General Surgery, Peking Union Medical College Hospital (PUMCH) over a continuous period, from January 2006 to December 2017.

Results

Over 12 years, 42 patients presented with a primary rectal GIST in PUMCH. Median age was 49 (range 27–77) years. Neoadjuvant imatinib (nIM) therapy was used in 16 patients, significantly reducing mean tumor size from 4.41 to 2.46 cm (p < 0.001) and mitotic index (p = 0.041). All of these patients underwent TEM with no tumor rupture, nIM therapy enabled sphincter-preserving surgery to be undertaken in 16 (16/42) patients who would otherwise have required abdominoperineal resection or pelvic exenteration for tumor clearance and all patients (42/42) achieve R0 resection and negative margin. Imatinib was also used as postoperative adjuvant treatment in 15 patients with high-risk GIST. Median follow-up was 77 (range 14–144) and overall survival is 100%. In 42 patients, Local recurrence (LR) occurred in 3 of 42 patients and 1 of 42 patients developed distant metastasis (DM) in 112 months after TEM. In the univariate analysis, mitotic index (p = 0.028), NIH risk categories (p = 0.047) were predictive feature of local relapse.

Conclusion

The application of nIM significantly decreased tumor size in large localized rectal GIST, which permitted TEM to preserve sphincter. The TEM procedure with alternative neoadjuvant imatinib therapy is a practicable treatment for patients with rectal GIST to preserve anus and have satisfied anal function.

Sheppard K, Kinross KM, Solomon B et al (2012) Targeting P13kinase/AKT/mTOR signaling in cancer. Crit Rev Oncog 17(1):69–95CrossRef

Joensuu H, Vehtari A, Riihimaki J et al (2012) Risk of recurrence of gastrointestinal stromal tumour after surgery: an analysis of pooled population-based cohorts. Lancet Oncol 13(3):265–274. https://doi.org/10.1016/S1470-2045(11)70299-6CrossRefPubMed

Tielen R, Verhoef C, van Coevorden F et al (2013) Surgical management of rectal gastrointestinal stromal tumors. J Surg Oncol 107:320–323CrossRef

Buess G, Theiss R, Hutterer F, Pichlmaier H, Pelz C, Holfeld T, Said S, Isselhard W (1983) Transanal endoscopic surgery of the rectum-testing a new method in animal experiments. Leber Magen Darm 13:73–77PubMed

Dematteo RP, Ballman KV, Antonescu CR et al (2009) Adjuvant imatinib mesylate after resection of localized, primary gastrointestinal stromal tumour: a randomised, double-blind, placebo controlled trial. Lancet 373:1097–1104CrossRef

Lo SS, Papachistou GI, Finkelstein SD, Conroy WP, Schraut WH, Ramanathan RK (2005) Neoadjuvant imatinib in gastrointestinal stromal tumor of the rectum: report of a case. Dis Colon Rectum 48:1316–1319CrossRef

Shah JN, Sun W, Seethala RR, Livolsi VA, Fry RD, Ginsberg GG (2005) Neoadjuvant therapy with imatinib mesylate for locally advanced GI stromal tumor. Gastrointest Endosc 61:625–627CrossRef

Santos Fernandes G, de Castro Cotti GC, Feitas D, Cutait R, Hoff PM (2009) Downstaging of rectal gastrointestinal stromal tumor by neoadjuvant imatinib therapy allowing for a conservative surgical approach. Clinics 64:819–821CrossRef

Wassenberg N, Nunoo-Mensah JW, Beart RW Jr, Ker TS (2007) Is there a role for neoadjuvant treatment with Gleevec for large rectal gastrointestinal stromal tumors? Int J Colorectal Dis 22:981–982CrossRef

10.

Jakob J, Mussi C (2013) Ulrich ronellenfitsch MD: gastrointestinal stromal tumor of the rectum: results of surgical and multimodality therapy in the era of imatinib. Ann Surg Oncol 20(2):586–592CrossRef

11.

Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O’Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH et al (2002) Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol 33:459–465CrossRef

12.

Goettsh G, Bos SD, Breekveldt-Potsma N, Casparie M, Herings RM, Hogendoorn PC (2005) Incidence of gastrointestinal stromal tumors is underestimated: results of a nationwide study. Eur J Cancer 41:2868–2872CrossRef

13.

Miettinen M, Lasota J (2006) Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol 23:70–83CrossRef

14.

Park KC, Kim HC, Park IJ, Yu CS, Kim JS, Kim JC (2004) Clinicopathologic and immunohistochemical features of gastrointestinal stromal tumors (GISTs) in the colon & rectum. J Korean Soc Coloproctol 20:371–377

15.

Choi SH, Kim SJ, Choi YJ, Min BS, Kim JS, Baik SH, Kim NK, Kang JG (2009) Clinicopathologic analysis of gastrointestinal stromal tumors of the colon and rectum. J Korean Soc Coloproctol 25:323–333CrossRef

16.

Paek OJ, Kim YB, Oh SY, Suh KW (2009) Gastrointestinal stromal tumors of the colon and rectum. J Korean Soc Coloproctol 25:318–322CrossRef

17.

Mussi C, Jakob J, Wardelmann E, Reichardt P, Casali PG, Fiore M, Collini P, Gronchi A, Hohenberger P (2008) Gastrointestinal stromal tumor of rectum and rectovaginal space: a retrospective review. J Clin Oncol 26:10560CrossRef

18.

Tsai MC, Lin JW, Lin SE, Chen HH, Lee CM, Hu TH (2008) Prognostic analysis of rectal stromal tumors by reference of National Institute of Health risk categories and immunohistochemical studies. Dis Colon Rectum 51:1535–1543CrossRef

19.

Miettinen M, Furlong M, Sarlomo-Rikala M, Burke A, Sobin LH, Lasota J (2001) Gastrointestinal stromal tumors intramural leïmyomas, and leïomyosarcomas in the rectum and anus: a clinicopathologic, immunohistochemical, and molecular genetic study of 144 cases. Am J Surg Pathol 25:1121–1123CrossRef

20.

Sturiale A, Martellucci J, Zurli L et al (2017) Long-term functional follow-up after anterior rectal resection for cancer. Int J Colorectal Dis 32:83–88CrossRef

21.

Demartines N, von Flüe MO, Harder FH (2001) Transanal endoscopic microsurgical excision of rectal tumors: indications and results. World J Surg 25(7):870–875CrossRef

22.

Huynh TK, Meeus P, Cassier P et al (2014) Primary localized rectal/pararectal gastrointestinal stromal tumors: results of surgical and multimodal therapy from the French Sarcoma group. BMC Cancer 14(1):156CrossRef

23.

Hohenberger P, Oladeji O, Licht T et al (2009) Neoadjuvant imatinib and organ preservation in locally advanced gastrointestinal stromal tumors (GIST). J Clin Oncol 27(suppl):548

24.

Wang D, Zhang Q, Blanke CD et al (2012) Phase II trial of neoadjuvant/adjuvant imatinib mesylate for advanced primary and metastatic/recurrent operable gastrointestinal stromal tumors: long-term follow-up results of Radiation Therapy Oncology Group 0132. Ann Surg Oncol 19:1074–1080CrossRef

25.

Jakob J, Mussi C, Ronellenfitsch U et al (2013) Gastrointestinal stromal tumor of the rectum: results of surgical and multimodality therapy in the era of imatinib. Ann Surg Oncol 20(2):586–592CrossRef

26.

Tang S, Yin Y, Shen C et al (2017) Preoperative imatinib mesylate (IM) for huge gastrointestinal stromal tumors (GIST). World J Surg Oncol 15(1):79CrossRef

27.

NCCN Clinical Practice Guidelines in Soft Tissue Sarcoma (NCCN Guidelines) (2019) Soft Tissue Sarcoma. Version 4. https://www.nccn.org. Accessed Mar 2019

28.

Wilkinson MJ, Fitzgerald JEF, Strauss DC et al (2015) Surgical treatment of gastrointestinal stromal tumour of the rectum in the era of imatinib. Br J Surg 102(8):965–971CrossRef

Title: Transanal endoscopic microsurgery with alternative neoadjuvant imatinib for localized rectal gastrointestinal stromal tumor: a single center experience with long-term surveillance
Authors: Xueshan Bai
Weixun Zhou
Yunhao Li
Guole Lin
Publication date: 01-07-2021
Publisher: Springer US
Keywords: Gastrointestinal Stromal Tumor
Imatinib
Published in: Surgical Endoscopy / Issue 7/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-07837-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Transanal endoscopic microsurgery with alternative neoadjuvant imatinib for localized rectal gastrointestinal stromal tumor: a single center experience with long-term surveillance

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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