Gastrointestinal stromal tumor surgery: Difference between revisions
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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 GIST. | ||
*Surgical resection offers an opportunity to completely cure GIST. | *Surgical resection offers an opportunity to completely cure GIST. | ||
*Laparoscopic resection | *Laparoscopic and endoscopic resection are the most preferred route of surgery. The indications for surgery include: | ||
**Symptomatic patients with locally advanced or metastatic disease. | **Symptomatic patients with locally advanced or metastatic disease. | ||
**Large lesions and tumors that are technically resectable if the risks of morbidity are acceptable | **Large lesions and tumors that are technically resectable if the risks of morbidity are acceptable | ||
* Surgical resection of GIST include complete gross resection with with an intact pseudocapsule and negative microscopic margins. | * Surgical resection of GIST include complete gross resection with with an intact pseudocapsule and negative microscopic margins. | ||
* In GIST, lymph node metastasis is rare and therefore lymphadenectomy | * 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]]. | * 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]]. | ||
Revision as of 14:40, 13 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 is surgical resection. Adjunctive chemotherapy/tyrosine Kinase Inhibitor therapy may be required.
Surgical Therapy
Surgery is the definitive therapy and typically the initial therapy for patients of 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:
- Symptomatic patients with locally advanced or metastatic disease.
- Large lesions and tumors that are technically resectable if the risks of morbidity are acceptable
- Surgical resection of GIST include complete gross resection with 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.
- Larger GISTs (>5 cm), and especially when the cell division rate is high (>6 mitoses/50 HPF), may disseminate and/or recur.
- 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 treatment and response rate has gone up from 5% to 40-70% in metastatic or inoperable cases.[1]
References