Gastrointestinal stromal tumor surgery
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:[1][2][3][4]
- 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.[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".