Gastrointestinal stromal tumor surgery: Difference between revisions
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{{Gastrointestinal stromal tumor}} | {{Gastrointestinal stromal tumor}} | ||
==Overview== | ==Overview== | ||
The | The mainstay of treatment for gastrointestinal stromal tumor (GIST) is surgical [[resection]]. Surgical [[resection]] offers an opportunity to completely cure GIST. [[Laparoscopic]] and [[endoscopic]] [[resection]] are the most preferred route of [[surgery]]. Surgical [[resection]] of GIST include complete gross [[resection]] with an intact pseudocapsule and negative [[microscopic]] margins. | ||
==Surgical Therapy== | ==Surgical Therapy== | ||
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* Most small GISTs (<5 and especially <2 cm) with a low rate of [[mitosis]] (<5 dividing cells per 50 high-power fields) are [[benign]] and, after surgery, do not require [[adjuvant therapy]] with [[tyrosine kinase inhibitors]]. | * Most small GISTs (<5 and especially <2 cm) with a low rate of [[mitosis]] (<5 dividing cells per 50 high-power fields) are [[benign]] and, after surgery, do not require [[adjuvant therapy]] with [[tyrosine kinase inhibitors]]. | ||
* Larger GISTs (>5 cm), and especially when the cell division rate is high (>6 [[mitosis|mitoses]]/50 HPF), may disseminate with surgery and/or recur and additionally may be treated with [[tyrosine kinase inhibitors]] | * Larger GISTs (>5 cm), and especially when the [[Cell (biology)|cell]] division rate is high (>6 [[mitosis|mitoses]]/50 HPF), may disseminate with surgery and/or recur and additionally may be treated with [[tyrosine kinase inhibitors]].<ref>{{Cite web | title =Gastrointestinal Stromal Tumors Treatment | ||
| url =http://www.cancer.gov/types/soft-tissue-sarcoma/hp/gist-treatment-pdq#section/_35}}</ref> | | url =http://www.cancer.gov/types/soft-tissue-sarcoma/hp/gist-treatment-pdq#section/_35}}</ref> | ||
**Previously GIST were resistant to conventional [[chemotherapy]] and had a mere success rate of <5%. | |||
** Previously GIST were resistant to conventional [[chemotherapy]] and had a mere success rate of <5%. | **With the advent of ''[[c-kit]]'' [[Protein kinase inhibitor|tyrosine kinase inhibitor]] such as [[imatinib]], the response rate has gone up from 5% to 40-70% in [[Metastasis|metastatic]] or inoperable cases. | ||
** With the advent of ''c-kit'' [[tyrosine kinase]] | |||
==References== | ==References== | ||
Latest revision as of 01:31, 4 March 2019
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]Parminder Dhingra, M.D. [3]
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Gastrointestinal stromal tumor Microchapters |
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Differentiating Gastrointestinal stromal tumor from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Gastrointestinal stromal tumor surgery On the Web |
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American Roentgen Ray Society Images of Gastrointestinal stromal tumor surgery |
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Directions to Hospitals Treating Gastrointestinal stromal tumor |
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Risk calculators and risk factors for Gastrointestinal stromal tumor surgery |
Overview
The mainstay of treatment for gastrointestinal stromal tumor (GIST) is surgical resection. Surgical resection offers an opportunity to completely cure GIST. Laparoscopic and endoscopic resection are the most preferred route of surgery. Surgical resection of GIST include complete gross resection with an intact pseudocapsule and negative microscopic margins.
Surgical Therapy
Surgery is the definitive therapy and typically the initial therapy for patients of gastrointestinal stromal tumor (GIST).
- Surgical resection offers an opportunity to completely cure GIST.
- Laparoscopic and endoscopic resection are the most preferred route of surgery. The indications for surgery include:[1][2][3][4]
- Surgical resection of GIST include complete gross resection with an intact pseudocapsule and negative microscopic margins.
- The GIST are highly vascular tumors and have a very fragile pseudocapsule and therefore the surgeon must be really careful regarding the risk of tumor rupture and subsequent peritoneal dissemination.
- In GIST, lymph node metastasis is rare and therefore lymphadenectomy and extensive lymph node exploration is rarely required.
- Most small GISTs (<5 and especially <2 cm) with a low rate of mitosis (<5 dividing cells per 50 high-power fields) are benign and, after surgery, do not require adjuvant therapy with tyrosine kinase inhibitors.
- Larger GISTs (>5 cm), and especially when the cell division rate is high (>6 mitoses/50 HPF), may disseminate with surgery and/or recur and additionally may be treated with tyrosine kinase inhibitors.[5]
- Previously GIST were resistant to conventional chemotherapy and had a mere success rate of <5%.
- With the advent of c-kit tyrosine kinase inhibitor such as imatinib, the response rate has gone up from 5% to 40-70% in metastatic or inoperable cases.
References
- ↑ Liang JW, Zheng ZC, Zhang JJ, Zhang T, Zhao Y, Yang W, Liu YQ (2013). "Laparoscopic versus open gastric resections for gastric gastrointestinal stromal tumors: a meta-analysis". Surg Laparosc Endosc Percutan Tech. 23 (4): 378–87. doi:10.1097/SLE.0b013e31828e3e9d. PMID 23917593.
- ↑ DE Vogelaere K, VAN DE Winkel N, Simoens C, Delvaux G (2013). "Intragastric SILS for GIST, a new challenge in oncologic surgery: first experiences". Anticancer Res. 33 (8): 3359–63. PMID 23898104. Vancouver style error: missing comma (help)
- ↑ De Vogelaere K, Hoorens A, Haentjens P, Delvaux G (2013). "Laparoscopic versus open resection of gastrointestinal stromal tumors of the stomach". Surg Endosc. 27 (5): 1546–54. doi:10.1007/s00464-012-2622-8. PMID 23233005.
- ↑ Ye L, Wu X, Wu T, Wu Q, Liu Z, Liu C, Li S, Chen T (2017). "Meta-analysis of laparoscopic vs. open resection of gastric gastrointestinal stromal tumors". PLoS ONE. 12 (5): e0177193. doi:10.1371/journal.pone.0177193. PMC 5423634. PMID 28486486.
- ↑ "Gastrointestinal Stromal Tumors Treatment".