Gastrointestinal stromal tumor surgery: Difference between revisions
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{{Gastrointestinal stromal tumor}} | {{Gastrointestinal stromal tumor}} | ||
==Overview== | ==Overview== | ||
The predominant therapy for gastrointestinal stromal tumor is surgical resection. | The predominant therapy 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== | ||
Surgery is the definitive therapy and typically the initial therapy for patients of GIST. | [[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. | *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:<ref name="pmid23917593">{{cite journal |vauthors=Liang JW, Zheng ZC, Zhang JJ, Zhang T, Zhao Y, Yang W, Liu YQ |title=Laparoscopic versus open gastric resections for gastric gastrointestinal stromal tumors: a meta-analysis |journal=Surg Laparosc Endosc Percutan Tech |volume=23 |issue=4 |pages=378–87 |year=2013 |pmid=23917593 |doi=10.1097/SLE.0b013e31828e3e9d |url=}}</ref><ref name="pmid23898104">{{cite journal |vauthors=DE Vogelaere K, VAN DE Winkel N, Simoens C, Delvaux G |title=Intragastric SILS for GIST, a new challenge in oncologic surgery: first experiences |journal=Anticancer Res. |volume=33 |issue=8 |pages=3359–63 |year=2013 |pmid=23898104 |doi= |url=}}</ref><ref name="pmid23233005">{{cite journal |vauthors=De Vogelaere K, Hoorens A, Haentjens P, Delvaux G |title=Laparoscopic versus open resection of gastrointestinal stromal tumors of the stomach |journal=Surg Endosc |volume=27 |issue=5 |pages=1546–54 |year=2013 |pmid=23233005 |doi=10.1007/s00464-012-2622-8 |url=}}</ref><ref name="pmid28486486">{{cite journal |vauthors=Ye L, Wu X, Wu T, Wu Q, Liu Z, Liu C, Li S, Chen T |title=Meta-analysis of laparoscopic vs. open resection of gastric gastrointestinal stromal tumors |journal=PLoS ONE |volume=12 |issue=5 |pages=e0177193 |year=2017 |pmid=28486486 |pmc=5423634 |doi=10.1371/journal.pone.0177193 |url=}}</ref> | *[[Laparoscopic]] and [[endoscopic]] resection are the most preferred route of surgery. The indications for surgery include:<ref name="pmid23917593">{{cite journal |vauthors=Liang JW, Zheng ZC, Zhang JJ, Zhang T, Zhao Y, Yang W, Liu YQ |title=Laparoscopic versus open gastric resections for gastric gastrointestinal stromal tumors: a meta-analysis |journal=Surg Laparosc Endosc Percutan Tech |volume=23 |issue=4 |pages=378–87 |year=2013 |pmid=23917593 |doi=10.1097/SLE.0b013e31828e3e9d |url=}}</ref><ref name="pmid23898104">{{cite journal |vauthors=DE Vogelaere K, VAN DE Winkel N, Simoens C, Delvaux G |title=Intragastric SILS for GIST, a new challenge in oncologic surgery: first experiences |journal=Anticancer Res. |volume=33 |issue=8 |pages=3359–63 |year=2013 |pmid=23898104 |doi= |url=}}</ref><ref name="pmid23233005">{{cite journal |vauthors=De Vogelaere K, Hoorens A, Haentjens P, Delvaux G |title=Laparoscopic versus open resection of gastrointestinal stromal tumors of the stomach |journal=Surg Endosc |volume=27 |issue=5 |pages=1546–54 |year=2013 |pmid=23233005 |doi=10.1007/s00464-012-2622-8 |url=}}</ref><ref name="pmid28486486">{{cite journal |vauthors=Ye L, Wu X, Wu T, Wu Q, Liu Z, Liu C, Li S, Chen T |title=Meta-analysis of laparoscopic vs. open resection of gastric gastrointestinal stromal tumors |journal=PLoS ONE |volume=12 |issue=5 |pages=e0177193 |year=2017 |pmid=28486486 |pmc=5423634 |doi=10.1371/journal.pone.0177193 |url=}}</ref> | ||
**Symptomatic patients with locally advanced | **Symptomatic patients with locally advanced disease. | ||
**Large lesions and | **Large [[lesions]] and [[tumors]] that are technically resectable if the risks of [[morbidity]] are acceptable. | ||
* Surgical resection of GIST include complete gross resection | * 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. | * 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. | * 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]]. | * 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 and/or recur. | * Larger GISTs (>5 cm), and especially when the cell division rate is high (>6 [[mitosis|mitoses]]/50 HPF), may disseminate and/or recur and may be treated with [[tyrosine kinase inhibitors]]. | ||
* 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'' [[tyrosine kinase]] inhibitor [[imatinib]] the | * 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.<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> | ||
Revision as of 15:22, 18 December 2017
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 predominant therapy 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 and/or recur and may be treated with tyrosine kinase inhibitors.
- 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.[5]
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".