scholarly journals Minimally Invasive Resection of Large Gastric Gastrointestinal Stromal Tumors

2020 ◽  
Vol 37 (6) ◽  
pp. 441-446
Author(s):  
Emma C. Gertsen ◽  
Gijs I. van Boxel ◽  
Lodewijk A.A. Brosens ◽  
Jelle P. Ruurda ◽  
Richard van Hillegersberg
Keyword(s):  
Minimally Invasive ◽  
Gastrointestinal Stromal Tumors ◽  
Tumor Regression ◽  
Medical Center ◽  
Disease Free Survival ◽  
Partial Gastrectomy ◽  
R0 Resection ◽  
Gastric Gist ◽  
Intraoperative Complication ◽  
Stromal Tumors

<b><i>Introduction:</i></b> Gastrointestinal stromal tumors (GISTs) frequently present as a large exophytically growing mass in the stomach, for which open partial gastrectomy is standard of care. The aim of this study was to evaluate the safety and feasibility of minimally invasive gastric resection (MIG) of large (&#x3e;5 cm) GIST. <b><i>Methods:</i></b> All patients who underwent MIG for a GIST in the University Medical Center Utrecht between 2011 and 2019 were included. Postoperative course and oncological outcomes were analyzed. <b><i>Results:</i></b> Twenty-two patients with gastric GIST, median size 53 mm [20–175 mm], underwent MIG. In 4 patients, preoperative imatinib was given, aiming for tumor regression. Conversion from laparoscopic to open surgery occurred once (5%). An additional resection was performed in 3 patients (14%). In 2 patients (9%), an intraoperative complication occurred, consisting of tumor rupture in 1 patient (5%), and 6 patients (27%) developed postoperative complications. Median hospital stay was 5 days [3–7 days]. R0 resection was achieved in 96%. In 4 patients, adjuvant treatment was indicated. The median follow-up was 31 months, and 1-, 3- and 5-year disease-free survival were 94, 74 and 74%, respectively. One patient presented with local recurrence 2 years after the index resection. <b><i>Conclusion:</i></b> MIG for large GIST up to 17.5 cm in diameter is safe, feasible, and oncologically sound, allowing for a controlled resection and reduced patient morbidity.

Gastrointestinal Stromal Tumors: Actin Expression, a New Prognostic Factor?

2010 ◽  
Vol 76 (11) ◽  
pp. 1244-1250 ◽  
Author(s):  
Jaime Ruiz-Tovar ◽  
María Diez-Tabernilla ◽  
Gada Housari ◽  
Enrique Martinez-Molina ◽  
Alfonso Sanjuanbenito
Keyword(s):  
Prognostic Factors ◽  
Small Bowel ◽  
Gastrointestinal Stromal Tumors ◽  
Abdominal Mass ◽  
Disease Free Survival ◽  
Gastric Gist ◽  
Free Survival ◽  
Stromal Tumors ◽  
Actin Expression ◽  
Disease Free

The aim of this study is to analyze the clinical outcome of gastrointestinal stromal tumors (GISTs) and to determine new prognostic factors. We perform a retrospective study of all the patients diagnosed with GIST in any location and operated on between 2000 and 2008 at our institution. We analyzed 35 patients, 16 males (45.7%) and 19 females (54.3%), with a mean age of 64 ± 13.8 years. The tumors were located in the stomach in 22 patients (62.9%), in the small bowel in 10 (28.6%), and the retroperitoneum in three (8.6%). Referring to gastric GIST, endoscopy revealed an ulceration in the mucosa in five cases, suggesting an epithelial neoplasm. In all these cases, pathology of the biopsy specimen was nonconclusive. Survival rate at 1 and 5 years was 94.3 and 88.6 per cent, respectively. Disease-free survival at 1 and 2 years was 91.4 and 88.6 per cent, respectively. Analyzing prognostic factors, a lower disease-free survival was observed among patients with constitutional syndrome at diagnosis ( P = 0.000), small bowel GIST ( P = 0.037), and tumors not expressing actin ( P = 0.015). A lower global survival was observed among men ( P = 0,036), patients with an abdominal mass ( P = 0.033) or with constitutional syndrome ( P = 0.007) at diagnosis and tumors at a retroperitoneal location ( P = 0.0002). Gastric GIST may be confused with epithelial neoplasms, modifying the surgery. In our patients, masculine gender, constitutional syndrome and abdominal mass at diagnosis, small bowel and retroperitoneal location, and actin negative tumors are bad prognostic factors.

The long-term outcome of gastrointestinal stromal tumors treatment

2021 ◽  
Vol 1 (4) ◽  
Author(s):  
Putticha Keawmanee ◽  
◽  
Wisit Kasetsermwiriya ◽  
Pakkapol Sukhvibul ◽  
Suphakarn Techapongsatorn ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Gastrointestinal Stromal Tumors ◽  
Disease Free Survival ◽  
Mitotic Figure ◽  
R0 Resection ◽  
Long Term Outcome ◽  
Free Survival ◽  
Stromal Tumors ◽  
Disease Free

Background: To evaluate the overall survival, disease free survival, clinicopathological characteristics and prognostic factors of patients with gastrointestinal stromal tumors (GISTs) who were treated at Faculty of Medicine Vajira Hospital. Methods: A retrospective review data of 39 GISTs patients who underwent surgery at Vajira hospital from 2007 to 2011 was performed. The patient characteristics, overall survival, disease-free survival of patients and prognostic factors were evaluated. Results: The median age of patients was 60 years (22-90 years), 54% were female and the main presenting symptom was abdominal pain (33%). Stomach (62%) and small intestine (30%) were the most common locations of tumor respectively. Complete resections (R0) were performed in 31 patients (80% ). All patients (100%) were positive for CD117 and 84.6% for CD34. According to the Armed Forces Institute of Pathology criteria, 56.4% of patients were characterized as a high risk. With a median follow-up time of 46 months (1-139 months). The overall survival and disease-free survival at 5 years were 84.6% and 66.7%, respectively. Two patients received Imatinib in neoadjuvant setting while 10 patients for disease control. Eight patients (20.5%) developed recurrences. R0 resection, mitotic figure and location of tumor were the significant prognostic factors. Conclusions: The overall survival and disease-free survival at 5 years were 84.6% and 66.7%, respectively. R0 resection, mitotic figure and location of tumor were the significant prognostic factors. Keywords: gastrointestinal stromal tumor; gists; prognostic factors; survival.

scholarly journals Hybrid Push-Pull Endoscopic and Laparoscopic Full Thickness Resection for the Minimally Invasive Management of Gastrointestinal Stromal Tumors: A Pilot Clinical Study

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Field F. Willingham ◽  
Paul Reynolds ◽  
Melinda Lewis ◽  
Andrew Ross ◽  
Shishir K. Maithel ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Endoscopic Resection ◽  
Gastrointestinal Stromal Tumors ◽  
Wedge Resection ◽  
Tertiary Care ◽  
R0 Resection ◽  
Full Thickness ◽  
Stromal Tumors ◽  
Gastric Gists ◽  
Deep Margin

Background. Gastric gastrointestinal stromal tumors (GISTs) that are predominantly endophytic or in anatomically complex locations pose a challenge for laparoscopic wedge resection; however, endoscopic resection can be associated with a positive deep margin given the fourth-layer origin of the tumors.Methods. Patients at two tertiary care academic medical centers with gastric GISTs in difficult anatomic locations or with a predominant endophytic component were considered for enrollment. Preoperative esophagogastroduodenoscopy (EGD), endoscopic ultrasound (EUS) with or without fine needle aspiration (FNA), and cross-sectional imaging were performed. Eligible patients were offered and consented for hybrid and standard management.Results. Over ten months, four patients in two institutions with anatomically complex or endophytic GISTs underwent successful, uncomplicated push-pull hybrid procedures. GIST was confirmed in all resection specimens.Conclusion. In a highly selected population, the hybrid push-pull approach was safe and effective in the removal of complex gastric GISTs. Endoscopic resection alone was associated with a positive deep margin, which the push-pull technique manages with a laparoscopic, full thickness, R0 resection. This novel, minimally invasive, hybrid laparoscopic and endoscopic push-pull technique is a safe and feasible alternative in the management of select GISTs that are not amenable to standard laparoscopic resection.

Is Endoscopic Resection of Gastric Gastrointestinal Stromal Tumors Safe?

2008 ◽  
Vol 74 (12) ◽  
pp. 1186-1189 ◽  
Author(s):  
Alyson L. Waterman ◽  
Stephen R. Grobmyer ◽  
William G. Cance ◽  
Steven N. Hochwald
Keyword(s):  
Endoscopic Resection ◽  
Gastrointestinal Stromal Tumors ◽  
Incidental Finding ◽  
Pelvic Mass ◽  
Partial Gastrectomy ◽  
Gastric Fundus ◽  
Upper Gastrointestinal Endoscopy ◽  
Gastric Gist ◽  
Stromal Tumors ◽  
Single Mass

Gastric gastrointestinal stromal tumors (GIST) commonly present as an incidental finding on upper gastrointestinal endoscopy. Advances in endoscopic technology have allowed some to perform attempted excision of these lesions endoscopically. The oncologic implications of such an approach remain unclear. A-74-year-old man initially presented with an incidental finding of a 1.6 x 1.8-cm c-kit-positive gastrointestinal stromal tumor with low mitotic activity in the gastric fundus. The patient underwent an attempted endoscopic resection of this mass resulting in incomplete excision and gastric perforation. There was immediate conversion to a celiotomy and the patient underwent partial gastrectomy; there was no evidence of metastatic GIST. Three years later, the patient was noted to have an asymptomatic large pelvic mass (4 x 7 cm) on CT scan and was referred for evaluation. Subsequent surgical exploration revealed a single mass adherent to the pelvic sidewall that was resected. Subsequent pathology demonstrated a c-kit-positive GIST consistent with metastatic disease. Eighteen months later, the patient remains free of disease. Complications from endoscopic resection of gastric GIST may be associated with peritoneal dissemination of disease. This should be considered when formulating a strategy for management of gastric GIST. Complete transperitoneal excision (either open or laparoscopic) with clear margins and without tumor rupture remains the gold standard for management of gastric GIST.

scholarly journals Clinical feasibility and safety of third space robotic and endoscopic cooperative surgery for gastric gastrointestinal stromal tumors dissection

2019 ◽  
Vol 33 (12) ◽  
pp. 4192-4200
Author(s):  
Feiyu Shi ◽  
Yingchao Li ◽  
Yanglin Pan ◽  
Qi Sun ◽  
Guanghui Wang ◽  
...  
Keyword(s):  
Adverse Events ◽  
Gastrointestinal Stromal Tumors ◽  
Third Space ◽  
Operation Time ◽  
R0 Resection ◽  
Gastric Gist ◽  
Minimal Invasiveness ◽  
Stromal Tumors ◽  
Gastric Gists ◽  
Mucosal Layer

Abstract Background Surgical management of gastric gastrointestinal stromal tumors (GISTs) has evolved towards minimal invasiveness. Laparoscopic wedge resection and laparoscopic and endoscopic cooperative surgery had been considered as standard surgical treatments for gastric GISTs > 2 cm. However, stomach deformation and the full-thickness gastric defect caused by these procedures may increase the risk of morbidity. To address these problems, we developed a novel technique, third space robotic and endoscopic cooperative surgery (TS-RECS), which could dissect the tumor entirely while preserving the intact mucosal layer. Here we performed a prospective evaluation of the feasibility and safety of TS-RECS. Methods Patients with gastric GISTs were recruited between April 2018 and April 2019. During the operation, the gastric GIST was located by endoscopic view firstly and the submucosal injection was performed. The tumor was then dissected through robotic surgery. Clinicopathological characteristics, operative data, adverse events, and follow-ups were prospectively collected and analyzed. Results A total of 20 patients with gastric GISTs received TS-RECS. The mean tumor size was 33.0 ± 7.3 mm. R0 resection was achieved in all patients with a median operation time of 115 min and a median blood loss of 20 ml. The integrity of mucosal layer was maintained in 95% (19/20) of the patients. All patients started oral diet on postoperative day 1 or 2, staying in the hospital for a median of 6 days after surgery. There were no major adverse events. Local or distant recurrences were not observed during a median follow-up period of 10 months. Conclusions Our study suggests that TS-RECS appears to be a feasible and safe technique which could be an alternative method for resecting gastric GISTs > 2 cm. Clinical Trials ClinicalTrials.gov NCT03804762.

scholarly journals Gastrointestinal Stromal Tumor (GIST) and Synchronous Intra-Abdominal Liposarcoma: A Report of Two Rare Cases and Literature Review

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Alexandros Diamantis ◽  
Athina A. Samara ◽  
Ioannis Baloyiannis ◽  
Dimitrios Symeonidis ◽  
Andreas-Marios Diamantis ◽  
...  
Keyword(s):  
Literature Review ◽  
Gastrointestinal Stromal Tumor ◽  
Current Literature ◽  
Gastrointestinal Stromal Tumors ◽  
Stromal Tumor ◽  
R0 Resection ◽  
Gastric Gist ◽  
Stromal Tumors ◽  
Retroperitoneal Liposarcoma ◽  
Electronic Search

Introduction. Gastrointestinal stromal tumors (GISTs) quite frequently occur synchronously with other malignancies, with most cases being adenocarcinomas. GISTs and liposarcomas are both of mesenchymal origin, and their coexistence is extremely rare. Methods. We conducted a review of the current literature regarding the synchronous occurrence of GISTs and intra-abdominal liposarcomas. An electronic search of the literature was undertaken using MEDLINE (database provider PubMed). Furthermore, we present the first described case of an 86-year-old male with a GIST and synchronous liposarcoma, both located in the stomach, as well as a 66-year-old male with a gastric GIST and concurrent retroperitoneal liposarcoma. Results. A total of 5 cases of synchronous GIST and intra-abdominal liposarcoma have been reported in the literature to date, with the most recent cases included in the present study. Conclusion. Further research is required to explain any possible correlation in the coexistence of these different neoplasms of the same origin. Meanwhile, R0 resection of both tumors remains the treatment of choice.

scholarly journals Prognostic Analysis of Duodenal Gastrointestinal Stromal Tumors

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Liwen Hong ◽  
Tianyu Zhang ◽  
Yun Lin ◽  
Rong Fan ◽  
Maochen Zhang ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Gastrointestinal Stromal Tumors ◽  
Disease Free Survival ◽  
Multivariate Regression Analysis ◽  
R0 Resection ◽  
Imatinib Treatment ◽  
Ki 67 ◽  
Stromal Tumors ◽  
Prognostic Analysis ◽  
Kaplan Meier

Aim. This study aims to analyze factors possibly related to the prognosis of duodenal gastrointestinal stromal tumors (DGISTs). Methods. We collected and retrospectively analyzed clinical and pathological data of 62 patients with primary DGISTs. All the patients were hospitalized and received complete surgical resection at Shanghai Ruijin Hospital from September 2003 to April 2015. We followed up the patients to determine survival outcomes. We also analyzed the effect of clinical and pathological factors on disease-free survival (DFS) and overall survival (OS) of the patients. Results. Kaplan-Meier univariate survival analysis demonstrated that tumor size, mitotic index, Ki-67 index, and pathological risk were correlated with the DFS and OS of the patients (DFS P=0.039, 0.001, <0.001, and 0.005, resp.; OS P=0.027, 0.007, <0.001, and 0.012, resp.). Cox multivariate regression analysis revealed that Ki-67 index was an independent prognostic factor affecting DFS and OS (P=0.007 and 0.028, resp.). Moreover, Kaplan-Meier survival analysis showed that imatinib treatment for patients with recurrence was correlated with prolonged OS (P=0.002). Conclusion. Prognosis for DGIST treated by R0 resection is favorable. High level of Ki-67 can be an independent risk factor of DGIST prognosis. Adjuvant imatinib therapy for patients with tumor recurrence could probably lead to prolonged survival.

Meta-Analysis on the Efficacy and Safety of Laparoscopic Surgery for Large Gastric Gastrointestinal Stromal Tumors

2020 ◽  
pp. 000313482095148
Author(s):  
Miao Yu ◽  
Deng-chao Wang ◽  
Jian Wei ◽  
Yue-hua Lei ◽  
Zhao-jun Fu ◽  
...  
Keyword(s):  
Gastrointestinal Stromal Tumors ◽  
Laparoscopic Resection ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Operation Time ◽  
Intraoperative Blood Loss ◽  
Open Resection ◽  
Free Survival ◽  
Stromal Tumors ◽  
Disease Free

Background The aim of this study was to conduct a meta-analysis comparing the safety and feasibility of laparoscopic versus open resection for gastric gastrointestinal stromal tumors (GISTs) larger than 5 cm. Method We searched the Cochrane Library, PubMed, and Embase for relevant articles. Randomized and nonrandomized clinical trials were identified and included in this study. Searching for related articles on large GIST (>5 cm) for laparoscopic resection (laparoscopic group [LAPG]) and open resection (open group [OG]), RevMan 5.3 was used for data analysis, comparing 2 groups of operation time, intraoperative blood loss, complications, length of hospital stay, recurrence rate, disease-free survival, and overall survival. Results Seven studies including 440 patients were identified for the meta-analysis. Meta-analysis revealed that LAPG had less bleeding, shorter postoperative hospital stay, and a better 5-year disease-free survival. There was no significant difference between LAPG and OG in operation time, postoperative complications, recurrence rate, and overall survival. Conclusion Laparoscopic resection of large (>5 cm) GIST is safe and feasible and has the advantages of less intraoperative blood loss and fast postoperative recovery, with a good outcome in the recent oncology.

Surgery for pancreatic cancer: current controversies and challenges

2021 ◽  
Author(s):  
Monish Karunakaran ◽  
Savio George Barreto
Keyword(s):  
Pancreatic Cancer ◽  
Minimally Invasive ◽  
Neoadjuvant Therapy ◽  
Disease Free Survival ◽  
Current Status ◽  
Preoperative Imaging ◽  
R0 Resection ◽  
Term Survival ◽  
Strict Adherence ◽  
Operative Morbidity

Two areas that remain the focus of improvement in pancreatic cancer include high post-operative morbidity and inability to uniformly translate surgical success into long-term survival. This narrative review addresses specific aspects of pancreatic cancer surgery, including neoadjuvant therapy, vascular resections, extended pancreatectomy, extent of lymphadenectomy and current status of minimally invasive surgery. R0 resection confers longer disease-free survival and overall survival. Vascular and adjacent organ resections should be undertaken after neoadjuvant therapy, only if R0 resection can be ensured based on high-quality preoperative imaging, and that too, with acceptable post-operative morbidity. Extended lymphadenectomy does not offer any advantage over standard lymphadenectomy. Although minimally invasive distal pancreatectomies offers some short-term benefits over open distal pancreatectomy, safety remains a concern with minimally invasive pancreatoduodenectomy. Strict adherence to principles and judicious utilization of surgery within a multimodality framework is the way forward.

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