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01-07-2009 | Original Article

Surgery for Gastrointestinal Stromal Tumors of the Stomach

Authors: Gerd R. Silberhumer, Martin Hufschmid, Fritz Wrba, Georg Gyoeri, Sebastian Schoppmann, Barbara Tribl, Etienne Wenzl, Gerhard Prager, Friedrich Laengle, Johannes Zacherl

Published in: Journal of Gastrointestinal Surgery | Issue 7/2009

Abstract

Background

Gastrointestinal stromal tumors (GISTs) are the main mesenchymal neoplasms in the gastrointestinal tract. Tumor size, mitotic rate, and location correlate with potential malignancy and recurrence rate. Results of surgical treatment of gastric GIST are analyzed with emphasis on recurrence of disease after intermediate follow-up.

Methods

From 1998 to 2006, a total of 63 patients (median age 62.1 ± 14.1) underwent gastric resection for GIST. Fifty-five patients (93.6%) returned for follow-up investigations, which included computed tomography in 45, gastroscopy in 32, and endosonography in 29. Positron emission tomography was done in five patients.

Results

Mean tumor size was 5.3 ± 3.8 cm. Open atypical gastric resection was done in 32, distal gastric resection in five, and remnant gastrectomy in four patients. Laparoscopic gastric resection was initiated in 22 patients; the conversion rate was four of 22 (18.2%). Overall, R0 resection was reached in 61/63 patients (96.8%). According to the Fletcher criteria, 33 tumors (52.4%) were classified as intermediate or high risk GIST. Six patients (9.5%) died of unrelated causes before follow-up. After a median follow-up of 2.5 years, overall recurrence rate was 7.0% after R0 resection.

Conclusion

Histologically proven complete resection is an effective treatment for gastric GIST. Laparoscopic procedures were carried out successfully in selected patients.

DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF. Two hundred gastrointestinal stromal tumors: Recurrence patterns and prognostic factors for survival. Ann Surg 2000;231:51–58. doi:10.1097/00000658-200001000-00008.PubMedCrossRef

Hirota S, Isozaki K. Pathology of gastrointestinal stromal tumors. Pathol Int 2006;56:1–9. doi:10.1111/j.1440-1827.2006.02036.x.PubMedCrossRef

Joensuu H. Sunitinib for imatinib-resistant GIST. Lancet 2006;368:1303–1304. doi:10.1016/S0140-6736(06)69489-0.PubMedCrossRef

Mazur MT, Clark HB. Gastric stromal tumors. Reappraisal of histogenesis. Am J Surg Pathol 1983;7:507–519.PubMed

Kindblom LG, Remotti HE, Aldenborg F, Meis-Kindblom JM. Gastrointestinal pacemaker cell tumor (GIPACT): Gastrointestinal stromal tumors show phenotypic characteristics of the interstitial cells of Cajal. Am J Pathol 1998;152:1259–1269.PubMed

Miettinen M, Virolainen M, Maarit Sarlomo R. Gastrointestinal stromal tumors–value of CD34 antigen in their identification and separation from true leiomyomas and schwannomas. Am J Surg Pathol 1995;19:207–216. doi:10.1097/00000478-199502000-00009.PubMed

Hirota S, Isozaki K, Moriyama Y, Hashimoto K, Nishida T, Ishiguro S, et al. Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Science 1998;279:577–580. doi:10.1126/science.279.5350.577.PubMedCrossRef

Koelz M, Wick N, Winkler T, Laengle F, Wrba F. The impact of c-kit mutations on histomorphological risk assessment of gastrointestinal stromal tumors. Eur Surg 2007;39:45–53. doi:10.1007/s10353-006-0299-8.CrossRef

Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, et al. Diagnosis of gastrointestinal stromal tumors: A consensus approach. Hum Pathol 2002;33:459–465. doi:10.1053/hupa.2002.123545.PubMedCrossRef

10.

Lee JR, Joshi V, Griffin JW Jr, Lasota J, Miettinen M. Gastrointestinal autonomic nerve tumor: Immunohistochemical and molecular identity with gastrointestinal stromal tumor. Am J Surg Pathol 2001;25:979–987. doi:10.1097/00000478-200108000-00001.PubMedCrossRef

11.

Rubin BP, Singer S, Tsao C, Duensing A, Lux ML, Ruiz R, et al. KIT activation is a ubiquitous feature of gastrointestinal stromal tumors. Cancer Res 2001;61:8118–8121.PubMed

12.

Kitayama H, Tsujimura T, Matsumura I, Oritani K, Ikeda H, Ishikawa J, et al. Neoplastic transformation of normal hematopoietic cells by constitutively activating mutations of c-kit receptor tyrosine kinase. Blood 1996;88:995–1004.PubMed

13.

Emory TS, Sobin LH, Lukes L, Lee DH, O'Leary TJ. Prognosis of gastrointestinal smooth-muscle (stromal) tumors: Dependence on anatomic site. Am J Surg Pathol 1999;23:82–87. doi:10.1097/00000478-199901000-00009.PubMedCrossRef

14.

Miettinen M, Lasota J. Gastrointestinal stromal tumors–definition, clinical, histological, immunohistochemical, and molecular genetic features and differential diagnosis. Virchows Arch 2001;438:1–12. doi:10.1007/s004280000338.PubMedCrossRef

15.

Pidhorecky I, Cheney RT, Kraybill WG, Gibbs JF. Gastrointestinal stromal tumors: Current diagnosis, biologic behavior, and management. Ann Surg Oncol 2000;7:705–712. doi:10.1007/s10434-000-0705-6.PubMedCrossRef

16.

Gold JS, Dematteo RP. Combined surgical and molecular therapy: The gastrointestinal stromal tumor model. Ann Surg 2006;244:176–184. doi:10.1097/01.sla.0000218080.94145.cf.PubMedCrossRef

17.

Fong Y, Coit DG, Woodruff JM, Brennan MF. Lymph node metastasis from soft tissue sarcoma in adults. Analysis of data from a prospective database of 1772 sarcoma patients. Ann Surg 1993;217:72–77. doi:10.1097/00000658-199301000-00012.PubMedCrossRef

18.

Fujimoto Y, Nakanishi Y, Yoshimura K, Shimoda T. Clinicopathologic study of primary malignant gastrointestinal stromal tumor of the stomach, with special reference to prognostic factors: Analysis of results in 140 surgically resected patients. Gastric Cancer 2003;6:39–48. doi:10.1007/s101200300005.PubMedCrossRef

19.

van der Zwan SM, DeMatteo RP. Gastrointestinal stromal tumor: 5 years later. Cancer 2005;104:1781–1788. doi:10.1002/cncr.21419.PubMedCrossRef

20.

Nguyen SQ, Divino CM, Wang JL, Dikman SH. Laparoscopic management of gastrointestinal stromal tumors. Surg Endosc 2006;20:713–716. doi:10.1007/s00464-005-0435-8.PubMedCrossRef

21.

Iwahashi M, Takifuji K, Ojima T, Nakamura M, Nakamori M, Nakatani Y, et al. Surgical management of small gastrointestinal stromal tumors of the stomach. World J Surg 2006;30:28–35. doi:10.1007/s00268-005-7944-4.PubMedCrossRef

22.

Bedard EL, Mamazza J, Schlachta CM, Poulin EC. Laparoscopic resection of gastrointestinal stromal tumors: Not all tumors are created equal. Surg Endosc 2006;20:500–503. doi:10.1007/s00464-005-0287-2.PubMedCrossRef

23.

Matthews BD, Walsh RM, Kercher KW, Sing RF, Pratt BL, Answini GA, et al. Laparoscopic vs open resection of gastric stromal tumors. Surg Endosc 2002;16:803–807. doi:10.1007/s00464-001-8319-z.PubMedCrossRef

24.

Blay JY, Bonvalot S, Casali P, Choi H, Debiec-Richter M, Dei Tos AP, et al. Consensus meeting for the management of gastrointestinal stromal tumors. Report of the GIST Consensus Conference of 20–21 March 2004, under the auspices of ESMO. Ann Oncol 2005;16:566–578. doi:10.1093/annonc/mdi127.PubMedCrossRef

25.

Langer C, Gunawan B, Schuler P, Huber W, Fuzesi L, Becker H. Prognostic factors influencing surgical management and outcome of gastrointestinal stromal tumours. Br J Surg 2003;90:332–339. doi:10.1002/bjs.4046.PubMedCrossRef

26.

Pierie JP, Choudry U, Muzikansky A, Yeap BY, Souba WW, Ott MJ. The effect of surgery and grade on outcome of gastrointestinal stromal tumors. Arch Surg 2001;136:383–389. doi:10.1001/archsurg.136.4.383.PubMedCrossRef

27.

Ng EH, Pollock RE, Munsell MF, Atkinson EN, Romsdahl MM. Prognostic factors influencing survival in gastrointestinal leiomyosarcomas. Implications for surgical management and staging. Ann Surg 1992;215:68–77.PubMedCrossRef

28.

Evans HL. Smooth muscle tumors of the gastrointestinal tract. A study of 56 cases followed for a minimum of 10 years. Cancer 1985;56:2242–2250. doi:10.1002/1097-0142(19851101)56:9<2242::AID-CNCR2820560918>3.0.CO;2-5.PubMedCrossRef

29.

Clary BM, DeMatteo RP, Lewis JJ, Leung D, Brennan MF. Gastrointestinal stromal tumors and leiomyosarcoma of the abdomen and retroperitoneum: A clinical comparison. Ann Surg Oncol 2001;8:290–299. doi:10.1007/s10434-001-0290-3.PubMedCrossRef

30.

Joensuu H, Fletcher C, Dimitrijevic S, Silberman S, Roberts P, Demetri G. Management of malignant gastrointestinal stromal tumours. Lancet Oncol 2002;3:655–664. doi:10.1016/S1470-2045(02)00899-9.PubMedCrossRef

31.

Novitsky YW, Kercher KW, Sing RF, Heniford BT. Long-term outcomes of laparoscopic resection of gastric gastrointestinal stromal tumors. Ann Surg 2006;243:738–745. discussion 745–747. doi:10.1097/01.sla.0000219739.11758.27.PubMedCrossRef

32.

Nishimura J, Nakajima K, Omori T, Takahashi T, Nishitani A, Ito T, et al. Surgical strategy for gastric gastrointestinal stromal tumors: Laparoscopic vs. open resection. Surg Endosc 2007;21:875–878. doi:10.1007/s00464-006-9065-z.PubMedCrossRef

33.

ACOSOG (2005) https://www.acosog.org/studies/closed.jsp.

34.

ACOSOG (2005) https://www.acosog.org/studies/synopses/Z9001.Synopsis.pdf.

35.

Tagaya N, Mikami H, Kogure H, Kubota K, Hosoya Y, Nagai H. Laparoscopic intragastric stapled resection of gastric submucosal tumors located near the esophagogastric junction. Surg Endosc 2002;16:177–179. doi:10.1007/s004640080158.PubMedCrossRef

Title: Surgery for Gastrointestinal Stromal Tumors of the Stomach
Authors: Gerd R. Silberhumer
Martin Hufschmid
Fritz Wrba
Georg Gyoeri
Sebastian Schoppmann
Barbara Tribl
Etienne Wenzl
Gerhard Prager
Friedrich Laengle
Johannes Zacherl
Publication date: 01-07-2009
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 7/2009
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-009-0872-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Surgery for Gastrointestinal Stromal Tumors of the Stomach

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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