Gastrointestinal Stromal Tumours of the Small Intestine.

OBJECTIVES: To describe the spectrum of small intestine gastrointestinal stromal tumour (GIST) cases; and to analyse prognostic factors. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Kartal Dr. Lütfi Kirdar City Hospital, Istanbul, Turkey, from 2010 to 2020. METHODOLOGY: Forty patients with small intestine GIST followed up between 2010-2020 were included in this study. The demographic information and clinical laboratory, histopathology, and radiology findings of all patients were analysed and compared. Five-year overall survival (OS) rate and five-year disease-free survival (DFS)were calculated. RESULTS: The mean patient age at diagnosis was 58.9 ± 12.6 years (34-79 years). Thirty-seven (92.5%) tumours were in the jejunum and ileum, and three (7.5%) were in the duodenum. The most common symptoms were bleeding (50%) and pain (37.5%). A total of 5% of the patients were asymptomatic, and 67.5% were in the high-risk group. Two patients (5%) died within a 30-day postoperative period, and 13 (32.5%) died during the follow-up period. The five-year overall survival (OS) rate was 54.2%. The mean five-year OS and five-year disease-free survival (DFS) were 47.5 ± 16.8 months and 40.9 ± 25.0 months, respectively. The mortality risk was calculated as 4.5-fold increased in the patients aged over 60 years and as 3.556-fold increased in those with recurrence/metastasis detected in their follow-ups. CONCLUSION: The OS ratio and OS duration were not as high as expected for small intestine GIST cases. Tumour diameter, mitotic index, and risk classification may not provide sufficient information for prognosis prediction in some cases. The frequency of recurrence and/or metastasis was higher than expected - although complete resection was achieved. Key Words: Gastrointestinal stromal tumours, Small intestine, Tumour diameter, Mitotic index.

Surgical results of Hartmann procedure in emergency cases with left-sided colorectal cancer.

OBJECTIVE: We aimed to define indication of Hartmann procedure (HP) under emergency conditions, analyze, and present in which cases this procedure should be used. METHODS: The patients who underwent emergency surgery for colorectal cancer were analyzed. Rates of mortality, overall, and disease-free survival of the patients were evaluated. The colostomy closure rate, operative mortality, and surgical complications of the secondary operation performed after the HP were also assessed. RESULTS: Fifty-seven patients who underwent HP were included in the study. The indications were obstruction (n = 37) or perforation (n = 20). The post-operative mortality and morbidity rates were 21.1% and 63.2%, respectively. The 1-, 3-, and 5-year survival rates for all patients were 54%, 49%, and 45%. CONCLUSION: HP can be a life-saving procedure in cases of high risk, emergency colorectal disease. Surgeons create a temporary stoma as a part of this procedure that is generally closed with a second operation. However, it is not possible to close the stoma in some cases, and the potential physical and emotional issues related to the stoma should be a part of the surgeon's considerations.

OBJETIVO: Definir la indicación del procedimiento de Hartmann en condiciones de emergencia y en qué casos debe utilizarse. MÉTODO: Se analizaron los pacientes sometidos a cirugía colorrectal de emergencia. Se evaluaron las tasas de mortalidad y de supervivencia global y libre de enfermedad. También se evaluaron la tasa de cierre de la colostomía, la mortalidad operatoria y las complicaciones quirúrgicas de la operación secundaria. RESULTADOS: Fueron incluidos en el estudio 57 pacientes sometidos a un procedimiento de Hartmann. Las indicaciones fueron obstrucción (n = 37) o perforación (n = 20). Las tasas de mortalidad y de morbilidad posoperatorias fueron del 21,1% y el 63,2%, respectivamente. Las tasas de supervivencia a 1, 3 y 5 años para todos los pacientes fueron del 54%, el 49% y el 45%. CONCLUSIÓN: El procedimiento de Hartmann puede salvar vidas en casos de enfermedad colorrectal de emergencia de alto riesgo. Los cirujanos crean un estoma temporal como parte de este procedimiento, que generalmente se cierra con una segunda operación. Sin embargo, en algunos casos no es posible cerrar la estoma, y los posibles problemas físicos y emocionales relacionados con este deberían ser parte de las consideraciones del cirujano.