Article

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

ABSTRACT 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.

Full-text

Available from: Seong-Ho Kong, Jun 15, 2015
0 Followers
 · 
146 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the gastrointestinal tract, but they represent less than 3% of all gastrointestinal tract malignancies. This is a detailed case study of a 52-year-old male patient treated for very uncommon histological subtype of gastric GIST with atypical clinical presentation, asymptomatic progress and late diagnosis. The resected tumour, giant in diameters, was confirmed to represent the most rare histopathologic subtype of GISTs - sarcomatoid epithelioid GIST. We report this case and review the literature with a special focus on pathomorphological evaluation, biological aggressiveness and prognostic factors. To our knowledge this is the first report of giant GIST of very uncommon sarcomatoid epithelioid subtype. It is concluded that clinicians should pay attention to the fact that initial diagnosis may be delayed due to mildly asymptomatic and non-specific clinical presentation. Asymptomatic tumours diagnosed at a late stage, which is often the case, can be large on presentation. Prognosis for patients diagnosed with GIST depend on tumour size, mitotic rate, histopathologic subtype and tumour location. That is why early diagnosis and R0 resection, which is usually feasible and safe even in giant gastric sarcomatoid epithelioid subtype of GISTs, are the key factors for further treatment and good prognosis.
    03/2015; 21(11):3388-93. DOI:10.3748/wjg.v21.i11.3388
  • Source
    [Show abstract] [Hide abstract]
    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.
    06/2014; 86(6):289-94. DOI:10.4174/astr.2014.86.6.289
  • [Show abstract] [Hide abstract]
    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 · 0.13 Impact Factor