Surgical Treatment of Gastric Gastrointestinal Stromal Tumor

Department of Surgery, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Journal of Gastric Cancer 03/2013; 13(1):3-18. DOI: 10.5230/jgc.2013.13.1.3
Source: PubMed


Gastrointestinal stromal tumor is the most common mesenchymal tumor in the gastrointestinal tract and is most frequently developed in the stomach in the form of submucosal tumor. The incidence of gastric gastrointestinal stromal tumor is estimated to be as high as 25% of the population when all small and asymptomatic tumors are included. Because gastric gastrointestinal stromal tumor is not completely distinguished from other submucosal tumors, a surgical excisional biopsy is recommended for tumors >2 cm. The surgical principles of gastrointestinal stromal tumor are composed of an R0 resection with a normal mucosa margin, no systemic lymph node dissection, and avoidance of perforation, which results in peritoneal seeding even in cases with otherwise low risk profiles. Laparoscopic surgery has been indicated for gastrointestinal stromal tumors <5 cm, and the indication for laparoscopic surgery is expanded to larger tumors if the above mentioned surgical principles can be maintained. A simple exogastric resection and various transgastric resection techniques are used for gastrointestinal stromal tumors in favorable locations (the fundus, body, greater curvature side). For a lesion at the gastroesophageal junction in the posterior wall of the stomach, enucleation techniques have been tried preserve the organ's function. Those methods have a theoretical risk of seeding a ruptured tumor, but this risk has not been evaluated by well-designed clinical trials. While some clinical trials are still on-going, neoadjuvant imatinib is suggested when marginally unresectable or multiorgan resection is anticipated to reduce the extent of surgery and the chance of incomplete resection, rupture or bleeding.

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    • "The treatment for a gastric GIST is complete surgical resection with a microscopically negative margin [17]. Although it appears to be simple, sometimes it is very difficult to perform such a simple task, especially when the tumor is located close to the GEJ or the pylorus. "
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    ABSTRACT: Purpose We hypothesized that gastroesophageal reflux disease (GERD) would be more prevalent after a gastric wedge resection of a submucosal tumor (SMT) located close to the gastroesophageal junction (GEJ) than after a gastric wedge resection of an SMT at other locations because of the damage to the lower esophageal sphincter during surgery. Methods Fifty-eight patients with gastric SMT who underwent open or laparoscopic gastric wedge resection between January 2000 and August 2012 at the Department of Surgery, Incheon St. Mary's Hospital were enrolled into this study. The patients were divided into 2 groups according to the location of the tumor, upper or lateral border of the tumor within 5 cm of the GEJ (GEJ ≤ 5 cm group) and upper or lateral border of the tumor greater than 5 cm distal to the GEJ (GEJ > 5 cm group). The surgical records, clinicopathologic findings, postoperative GERD symptoms, postoperative use of acid suppressive medications and preoperative and postoperative endoscopic findings were retrospectively reviewed and compared between the 2 groups. Results There was no difference in the frequency of the preoperative GERD symptoms between the 2 groups, whereas postoperative GERD symptoms and postoperative use of acid suppressive medications were more frequent in the GEJ ≤ 5 cm group (P = 0.045 and P = 0.031). However, there were no differences in the follow-up endoscopic findings in terms of reflux esophagitis and Hill's grade between the 2 groups. Conclusion The incidence of GERD was higher after gastric wedge resection of SMTs located close to the GEJ. Hence, adequate care should be taken during the follow-up of these patients.
    Annals of Surgical Treatment and Research 06/2014; 86(6):289-94. DOI:10.4174/astr.2014.86.6.289
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    • "Complete surgical resection is the only curative treatment for GISTs [8]. However, the recent introduction of specific pathogenesis-targeted treatments with a Kit tyrosine kinase inhibitor, imatinib mesylate (Glivec®, Novartis Pharma S.A.S, France), has resulted in significant improvements in non-resectable patients (a palliative cure), and it has been successfully used as adjuvant therapy for tumors with a high risk of relapse [4]. "
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    ABSTRACT: Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors that originate from interstitial cells of Cajal or their stem cell-like precursors. Generally, GISTs have specific c-KIT gene mutations. The incidence of GISTs is estimated to be 10 to 20 cases/one million individuals, and GISTs typically affect people over 50 years of age. The majority of GISTs are solitary. However, multifocal GISTs have been observed, especially in children. We report on two unusual adult cases of double GISTs that were treated by laparoscopic surgery. The first patient presented a polypoid mass of the fundus and a second isolated smaller tumor in the posterior wall of the lesser curvature of the stomach. A histopathological examination confirmed that both tumors were GISTs and were c-KIT-positive. A total laparoscopic gastrectomy was performed. In the second patient, GISTs were identified at the level of the fundus and the greater curvature of the stomach. A laparoscopic partial sleeve gastrectomy was performed. Both surgeries were successful with no complications or relapses at three to five years following surgery.
    World Journal of Surgical Oncology 03/2014; 12(1):76. DOI:10.1186/1477-7819-12-76 · 1.41 Impact Factor
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    ABSTRACT: Die fortschreitende Entwicklung molekularbiologischer Analysen ermöglicht den zunehmenden schnellen klinischen Einsatz von Biomarkern. Eingebettet in multimodale Therapiekonzepte ist es auch Aufgabe des Chirurgen, prädiktive, prognostische und therapeutische Biomarker zu verstehen und für die Behandlungsstrategie zu berücksichtigen. Dies ist ein wichtiger Baustein in einer auf den Patienten zugeschnittenen modernen Tumortherapie.Selektive Literaturrecherche.Mit dem Einsatz dieser Techniken und Konzeptionen sind aber auch besondere Anforderungen an die chirurgisch-onkologische Ausbildung geknüpft, um die molekularen Zusammenhänge zu verstehen, die Grenzen und das Einsatzspektrum zu kennen und hiermit in Zusammenhang stehende Folgen und Komplikationsmöglichkeiten frühzeitig zu erkennen und zu beherrschen. Um dem neuen inhaltlichen und konzeptionellen Fortschritt Rechnung zu tragen, bedeutet dies für den Chirurgen, sich vom reinen Tumoroperateur zum chirurgischen Onkologen zu entwickeln. Die Kenntnis und das Abwägen zwischen chirurgischer Technik, Tumorbiologie und therapeutischer bzw. psychologischer Belastbarkeit des Patienten mit einem ständigen wissenschaftlichen Hinterfragen unterscheidet die chirurgische Onkologie von der reinen Tumorchirurgie.
    Der Onkologe 10/2013; 19(10). DOI:10.1007/s00761-013-2499-8 · 0.14 Impact Factor
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