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1.
Gan To Kagaku Ryoho ; 48(3): 385-387, 2021 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-33790163

RESUMO

A 50s old woman admitted to our hospital with anal pain, who was diagnosed as rectal gastrointestinal stromal tumor (GIST). After neoadjuvant therapy with imatinib mesylate for 6 months, the tumor reduced by 75% from its original size and anus preserving operation(low anterior resection)was performed. After operation adjuvant therapy with imatinib mesylate was performed for 2 years and 6 months. The patient is alive without recurrence 5 years after surgery. It is suggested that neoadjuvant therapy with imatinib mesylate is useful and safety for large rectal GIST, from the standpoint of anal preservation.


Assuntos
Antineoplásicos , Tumores do Estroma Gastrointestinal , Laparoscopia , Neoplasias Retais , Canal Anal/cirurgia , Antineoplásicos/uso terapêutico , Feminino , Tumores do Estroma Gastrointestinal/tratamento farmacológico , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Mesilato de Imatinib/uso terapêutico , Terapia Neoadjuvante , Recidiva Local de Neoplasia , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/cirurgia
2.
Gan To Kagaku Ryoho ; 48(3): 422-424, 2021 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-33790175

RESUMO

We report a case of gastrointestinal submucosal tumor with an intraluminal growth pattern resected by laparoscopic wedge resection. A 62-year-old man was admitted because of melena. Upper gastrointestinal endoscopy revealed gastrointestinal submucosal tumor with an intraluminal growth pattern just below the gastric junction, and the pathological diagnosis was GIST. A laparoscopic wedge resections(percutaneous endoscopic intragastric surgery)was performed by a single access port. After laparotomy 5 cm above the umbilicus, the anterior wall of the middle part of the stomach was incised and fixed to the skin, and the tumor was dissected with a linear stapler. The final pathology result showed a high risk GIST of 70×40 mm with 110 mitotic images/50 HPF, and the patient was treated with imatinib mesylate adjuvant chemotherapy. There were no complications, including postoperative transit disturbances, and there were no local or distant metastatic recurrences.


Assuntos
Neoplasias Gastrointestinais , Tumores do Estroma Gastrointestinal , Laparoscopia , Neoplasias Gástricas , Gastrectomia , Tumores do Estroma Gastrointestinal/tratamento farmacológico , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/cirurgia
3.
BMC Surg ; 21(1): 111, 2021 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-33658035

RESUMO

BACKGROUND: Gastrointestinal stromal tumor (GIST) can arise anyplace along the gastrointestinal (GI) tract. The uncommon tumor location in groin area is rarely reported. CASE PRESENTATION: We herein reported a metastasized case presented as GI hemorrhage complicated with indirect hernia, and underwent tumor cytoreduction, herniorrhaphy and chemotherapy for jejunal GIST. The case was described consecutively based on the process of surgical management, with a good follow-up result. A literature review by searching similar case reports from two national medical databases was performed to summarize clinical features of such unusual presentation of GIST, which included hernia characteristics, short- and long-term outcomes of this disease. It showed GIST presenting as groin hernia was rarely reported and all available 11 cases suggested a primary tumor and required both tumor resection and hernia repair. The long-term results indicated 64.3% overall survival at 5 years after the incidental diagnosis. CONCLUSIONS: Inguinal hernia is an extremely rare presentation of GIST, with limited case reports available in the literature. A radical involving tumor resection plus hernia repair is an optimal surgical approach for such uncommon condition. An adjuvant medication mounting on mutated KIT gene should be strictly followed for high risk cases.


Assuntos
Tumores do Estroma Gastrointestinal , Hérnia Inguinal , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/cirurgia , Hérnia Inguinal/complicações , Hérnia Inguinal/cirurgia , Humanos
4.
Gan To Kagaku Ryoho ; 48(2): 257-259, 2021 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-33597374

RESUMO

The patient was a 77-year-old woman. She underwent a partial gastrectomy at the age of 40, and a partial colectomy at the age of 75 following a diagnosis of a carcinoid. In November 2019, a 1.5 cm mass with a clear boundary was found in the pancreatic tail, which was strongly stained uniformly. And furthermore, multiple masses between 2 cm and 3 cm with a clear boundary was found inside liver segment S1 and S6 and S7 and S8 on CT, which was strongly stained at the edge in the early phase and was seen as a low density area in the late phase. At a result of image examination, it was diagnosed as a pancreatic tail neuroendocrine tumor and its multiple liver metastases. The distal pancreatectomy, posterior segmentectomy, and partial S1 lt and S8 liver resection were performed. With postoperative pathological diagnosis, the pancreatic tumor was accessory spleen, and liver tumor were epithelioid type GIST which were positive for CD34 and PDGFRA and negative for c- kit. The pathology specimen of colectomy was re-examined, and the diagnosis from the previous surgery was changed to GIST from a carcinoid. Epithelioid type GIST was associated with a PDGFRA gene mutation and was known to have many gastric origins. Based on the clinical course, it was diagnosed as recurrence of gastric GIST at 40 years after 30 years or more.


Assuntos
Tumores do Estroma Gastrointestinal , Neoplasias Gástricas , Idoso , Feminino , Gastrectomia , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Recidiva Local de Neoplasia , Proteínas Proto-Oncogênicas c-kit , Neoplasias Gástricas/cirurgia
5.
Gan To Kagaku Ryoho ; 48(2): 269-272, 2021 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-33597378

RESUMO

A 67-year-old woman was admitted with melena. A colonoscopy detected a 50 mm submucosal tumor close to the dentate line. We diagnosed the rectal gastrointestinal stromal tumor by EUS-FNA. With the expectation of tumor shrinkage and strong hope of the patient, we started imatinib mesylate as neoadjuvant chemotherapy. A CT scan after 3 months after administration of imatinib mesylate showed the reduction of the size to 35 mm. We operated transanal endoscopic surgery considering the localization of the tumor. From histopathological findings, the tumor was low risk in the modified-Fletcher classification, and low risk in the Miettinen classification. Eight months after the operation, no recurrence was observed without further adjuvant chemotherapy. In this case, we were able to resect the tumor without injuring the film of tumor by operating transanal endoscopic surgery, because of tumor shrinkage with imatinib mesylate as neoadjuvant chemotherapy. I considered that using imatinib mesylate preoperatively was contributed to minimally invasive surgery.


Assuntos
Antineoplásicos , Tumores do Estroma Gastrointestinal , Neoplasias Retais , Idoso , Antineoplásicos/uso terapêutico , Feminino , Tumores do Estroma Gastrointestinal/tratamento farmacológico , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Mesilato de Imatinib/uso terapêutico , Procedimentos Cirúrgicos Minimamente Invasivos , Terapia Neoadjuvante , Recidiva Local de Neoplasia , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/cirurgia , Reto
6.
Zhonghua Wei Chang Wai Ke Za Zhi ; 24(2): 167-172, 2021 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-33508923

RESUMO

Objective: To investigate the safety and feasibility of laparoscopic double-flap technique (Kamikawa) in digestive tract reconstruction after proximal gastrectomy for esophagogastric junction (EGJ) leiomyoma and gastrointestinal stromal tumor (GIST) with the maximum diameter >5 cm. Methods: A descriptive case-series study was used to retrospectively analyze the data of patients with EGJ leiomyoma and GIST undergoing laparoscopic-assisted proximal gastrectomy and double-flap technique (Kamikawa) at the Department of Gastrointestinal Surgery, Guangdong Hospital of Traditional Chinese Medicine from September 2017 to March 2019. All the tumors invaded the cardia dentate line, and the maximum diameter was >5 cm. After the exclusion of patients requiring emergency surgery and complicating with severe cardiopulmonary diseases, a total of 4 patients, including 3 males and 1 female with age of 29-49 years, were included in this study. After laparoscopic-assisted proximal gastrectomy, the residual stomach was pulled out of the abdominal cavity and marked with methylene blue at the proximal end 3~4 cm from the anterior wall of the residual stomach in the shape of "H". The gastric wall plasma muscular layer was cut along the "H" shape, and the space between the submucosa and the muscular layer was separated to both sides along the longitudinal incision line to make the seromuscular flap. The residual stomach was put back into the abdominal cavity. Under laparoscopy, 4 stitches were intermittently sutured at the upside of "H" shape and 4-5 cm from the posterior wall of the esophageal stump. The stump of the esophagus was cut open, and the submucosa and mucosa were cut under the "H" shape to enter the gastric cavity. The posterior wall of the esophageal stump was sutured continuously with the gastric stump mucosa and submucosa under laparoscopy. The anterior wall of the esophageal stump was sutured continuously with the whole layer of the residual stomach. The anterior wall of the stomach was sutured to cover the esophagus. The anterior gastric muscle flap was sutured and embedded in the esophagus to complete the reconstruction of digestive tract. The morbidity of intraoperative complications and postoperative reflux esophagitis and anastomosis-related complications were observed. Results: All the 4 patients completed the operation successfully, and there was no conversion to laparotomy. The median operative time was 239 (192-261) minutes, the median Kamikawa anastomosis time was 149 (102-163) minutes, and the median intraoperative blood loss was 35 (20-200) ml. The abdominal drainage tube and gastric tube were removed, and the fluid diet was resumed on the first day after surgery in all the 4 patients. The median postoperative hospitalization time was 6 (6-8) days. Postoperative pathology revealed 3 leiomyomas and 1 GIST. There were no postoperative complications such as anastomotic leakage or stenosis, and no reflux symptoms were observed. The median follow-up time was 22 (11-29) months after the operation, and no reflux esophagitis occurred in any of the 4 patients by gastroscopy. Conclusion: For >5 cm EGJ leiomyoma or GIST, double-flap technique (Kamikawa) used for digestive tract reconstruction after proximal gastrectomy is safe and feasible.


Assuntos
Junção Esofagogástrica , Esôfago/cirurgia , Tumores do Estroma Gastrointestinal , Leiomioma , Neoplasias Gástricas , Estômago/cirurgia , Adulto , Anastomose Cirúrgica/métodos , Junção Esofagogástrica/cirurgia , Estudos de Viabilidade , Feminino , Gastrectomia/métodos , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Laparoscopia , Leiomioma/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia , Retalhos Cirúrgicos , Resultado do Tratamento
7.
Gan To Kagaku Ryoho ; 48(1): 101-103, 2021 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-33468734

RESUMO

A 71-year-old man underwent total gastrectomy with Roux-en-Y reconstruction for gastric GIST in October 2017. Liver metastasis was identified in June 2019, and chemotherapy with imatinib was started in July. In December, the patient presented with acute upper abdominal pain and back pain. Abdominal contrast-enhanced CT showed that the jejunum extending from the duodenal stump was dilated. In addition, part of the jejunum had a poor wall contrast effect, with ascites also found surrounding it. We suspected a strangulated ileus and immediately performed emergency surgery. We found an internal hernia with incarceration of the afferent loop at the Petersen's defect. The time from the onset of symptoms to the surgery was relatively short, and the surgery was completed with hernial repair and closure of the hernial orifice without the development of bowel necrosis; the patient's postoperative course was good. Although the frequency of internal hernia after gastrectomy is relatively low, there is a risk that it may be severe if it occurs. Therefore, care should be taken to not cause internal hernias during surgery, and an internal hernia should be considered in the event of sudden abdominal pain after gastric surgery.


Assuntos
Derivação Gástrica , Tumores do Estroma Gastrointestinal , Hérnia Abdominal , Laparoscopia , Neoplasias Hepáticas , Idoso , Gastrectomia , Tumores do Estroma Gastrointestinal/tratamento farmacológico , Tumores do Estroma Gastrointestinal/cirurgia , Hérnia Abdominal/cirurgia , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/cirurgia , Masculino
8.
Anticancer Res ; 41(1): 21-25, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33419796

RESUMO

BACKGROUND/AIM: Gastrointestinal stromal tumor (GIST) has a wide spectrum of clinical manifestations. Involvement of the groin region can cause interesting presentations but, as of 2020, has rarely been investigated. Our aim was to assess the clinicopathological and prognostic features of GIST appearing in this specific part of the body. MATERIALS AND METHODS: We investigated the world literature dealing with primary or metastatic GIST appearing in the inguinal region (IGIST). A case of metastatic IGIST from our clinical records was also included. RESULTS: We found only six cases of primary and nine of metastatic IGIST. All were of male gender, and most aged 60 years or more (10 cases). Inguinal hernia (11 cases) was the patient type most frequently affected. The association between metastatic IGIST and inguinal lymphadenopathy was statistically significant (p=0.049). CONCLUSION: IGIST is a rare entity with particular clinical manifestations. Inguinal hernia and inguinal lymphadenopathy should be carefully investigated in patients with a history of GIST.


Assuntos
Tumores do Estroma Gastrointestinal/diagnóstico , Virilha/patologia , Gerenciamento Clínico , Tumores do Estroma Gastrointestinal/secundário , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Metástase Neoplásica , Estadiamento de Neoplasias , Avaliação de Sintomas , Resultado do Tratamento
9.
Am J Surg ; 221(1): 183-186, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32782081

RESUMO

BACKGROUND: Transanal endoscopic microsurgery (TEM) is effective in treating adenomas and select early rectal cancers. Our objective is to evaluate TEM in treating early rectal GISTs. METHODS: Patients were identified in a prospective database with pathology confirmed rectal GIST prior to TEM over 10 years. Demographic, pathologic, operative and follow-up data was analysed and presented with descriptive statistics. RESULTS: 7 cases of rectal GIST were treated with TEM with a follow-up time of 31 months (0-71). Median tumor distance from the anal verge was 4 cm (2.5-6) and median tumor size was 3 cm (2-5.7). Negative margins were achieved in 4/7 patients. Those with positive margins were treated with repeat TEM or imatinib. 1 patient had local recurrence successfully treated by TEM. CONCLUSIONS: Overall, TEM is safe for locally excising GISTs. As rectal GISTs are rare, a multicenter registry may better elucidate outcomes with this treatment.


Assuntos
Tumores do Estroma Gastrointestinal/cirurgia , Neoplasias Retais/cirurgia , Microcirurgia Endoscópica Transanal , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
10.
Am J Surg ; 221(3): 549-553, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33371951

RESUMO

BACKGROUND: Few studies evaluate the relationships between surgical approach, histologic margin, and overall survival in gastrointestinal stromal tumor. We test the hypothesis that margin positive resection is associated with compromised overall survival. METHODS: We queried the National Cancer Data Base to identify patients undergoing resections for gastrointestinal stromal tumors ≤3 cm in size between 2010 and 2015. Multivariable logistic regression was used to identify factors associated with positive microscopic margins on final pathology. Cox proportional hazard methods were used to evaluate factors associated with overall survival. RESULTS: 2064 patients met inclusion criteria; 135 (6.5%) had a microscopically positive surgical margin. On multivariable regression, minimally invasive approach was not associated with risk of a positive margin (OR 1.06 95% CI [0.71, 1.59]). On Cox analysis, positive margin status was not associated with OS (R1: 1.03, CI [0.46-2.31], reference R0). CONCLUSIONS: Positive microscopic surgical margins are not associated with compromised overall survival in patients undergoing resection of small gastrointestinal stromal tumors. Minimally invasive surgical approaches do not compromise oncologic outcomes in these cases.


Assuntos
Neoplasias Gastrointestinais/mortalidade , Neoplasias Gastrointestinais/cirurgia , Tumores do Estroma Gastrointestinal/mortalidade , Tumores do Estroma Gastrointestinal/cirurgia , Margens de Excisão , Idoso , Bases de Dados Factuais , Feminino , Neoplasias Gastrointestinais/patologia , Tumores do Estroma Gastrointestinal/patologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida
11.
Niger J Clin Pract ; 23(12): 1776-1779, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33355835

RESUMO

Gastrointestinal tumors are uncommonly found outside the gastrointestinal tract, and extremely rare in the vaginal wall. In this case report, a 39-year-old female, she was finally diagnosed with an extra gastrointestinal stromal tumor (EGIST) when she presented with a recurrent vaginal tumor, while misdiagnosed after the first surgery. She had definitive surgical clearance and was taking targeted drug therapy with no sign of recurrence after follow-up for 13 months. Immunohistochemistry and cytogenetic's remain the most definitive method to diagnose EGISTs. Surgical resection and postoperative adjuvant targeted therapy are the optimum treatment options.


Assuntos
Tumores do Estroma Gastrointestinal , Adulto , Terapia Combinada , Feminino , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Imuno-Histoquímica , Recidiva Local de Neoplasia , Vagina/cirurgia
12.
Chirurgia (Bucur) ; 115(6): 726-734, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33378631

RESUMO

Introduction: Laparoscopic techniques have been increasingly adopted in the field of General Surgery in the last decades. The main disadvantages of laparoscopy are related to limited degrees of freedom of instruments and poor ergonomics, which are associated with a steep learning curve. Robotic surgery overcomes most of the technical limitations of laparoscopic surgery and has the potential to expand the indications of minimal access surgery (MAS) in procedures that are difficult to perform using laparoscopy. Methods: Patients who underwent MAS resections of gastric gastrointestinal stromal tumours (GIST) between January 2002 and October 2018 in a single Surgical Department were retrospectively analysed. Demographic data as well as the following characteristics were recorded for each patient: age, sex, symptoms, tumour location and size, type of surgical procedure, intraoperative blood loss, operative time, length of hospital stay, histopathological assessment of resection margins, and incidence of perioperative complications. Results: The mean patient age was 58 (range, 27-81 years). Most lesions were found on the great curvature (7) and in the distal stomach or antrum (7), respectively. Twenty patients underwent laparoscopic resection, while five patients had robotic resection of gastric GISTs. Surgical laparoscopic treatment consisted of antrectomy (n=4) and wedge gastrectomy (n=16). In all robotic cases a wedge gastrectomy was performed. One patient was converted to open surgery due to adhesions from previous operation. The mean operative time was 130 minutes (range, 70-210 minutes).The mean tumour size was 3.8 cm (range, 2-7 cm). There were no complications except one case that required reoperation for postoperative bleeding. There were no mortalities. Conclusion: The MAS approach of gastric GISTs is safe and effective and it is associated with low morbidity. Therefore, it should constitute the first option in patients with small tumours and favourable locations. The only limiting factor for the widespread use of MAS resections for gastric GISTs is surgeon expertise in this challenging technique.


Assuntos
Gastrectomia/métodos , Tumores do Estroma Gastrointestinal , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Neoplasias Gástricas , Adulto , Idoso , Idoso de 80 Anos ou mais , Competência Clínica , Gastrectomia/normas , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia , Resultado do Tratamento
13.
Surg Clin North Am ; 100(6): 1201-1214, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33128889

RESUMO

Minimally invasive endoscopic resection procedures continue to evolve, with submucosal tunneling endoscopic resection (STER) being a durable option for en bloc resection of submucosal tumors. Whether STER can be effectively used for larger (>3.5 cm) lesions remains to be seen. STER-ET is a novel approach for removal of extraluminal tumors, but data are currently limited to support its use.


Assuntos
Ressecção Endoscópica de Mucosa/métodos , Tumores do Estroma Gastrointestinal/cirurgia , Membrana Mucosa/cirurgia , Trato Gastrointestinal Superior/cirurgia , Mucosa Esofágica/cirurgia , Mucosa Gástrica/cirurgia , Neoplasias Gastrointestinais/cirurgia , Humanos
15.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(9): 823-834, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32927504

RESUMO

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor in the gastrointestinal tract. The successful application of molecular targeted agents has promoted the clinical diagnosis and treatment of GIST into the era of precision medicine. There are some pitfalls in the diagnosis (including preoperative diagnosis and pathological diagnosis), surgical treatment (including surgical procedure, minimally invasive surgery, and surgery for recurrent/metastatic GIST) and drug treatment (including duration of adjuvant therapy for very high risk GIST and timing of intervention during preoperative treatment) of GIST. In addition to difficulties of doctors, these pitfalls can also lead to waste of medical resources, and even endanger the health and life of patients. Each doctor engaged in the diagnosis and treatment of GIST needs to fully understand the biological characteristics and disease development pattern of GIST, and accurately recognize every possible trap in the clinical management. This paper analyzes the pitfalls and misunderstandings in various aspects of GIST diagnosis and treatment in order to provide clues for promoting more reasonable clinical decision-making.


Assuntos
Neoplasias Gastrointestinais/diagnóstico , Neoplasias Gastrointestinais/terapia , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/terapia , Tomada de Decisão Clínica , Neoplasias Gastrointestinais/cirurgia , Tumores do Estroma Gastrointestinal/cirurgia , Humanos
16.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(9): 835-839, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32927505

RESUMO

The actual incidence of small gastrointestinal stromal tumors (GIST) increases gradually. Although the biological behavior of most of small GIST is benign or indolent, a few small GIST can develope to recurrence and metastasis with biological invasive behavior. Identification of biological behavior and malignant potential is the cornerstone of treatment. For non-gastric small GIST, surgery is always the treatment of choice. Regarding gastric small GIST, close follow-up is acceptable for patients without risk factors detected by endoscopic ultrasonography. Surgery should be suggested for those with high risks, or significant growth of tumor during follow-up. Complete resection with function preservation is the principle of surgery. Besides, individualized treatment should also be taken into consideration.


Assuntos
Neoplasias Gastrointestinais/diagnóstico , Neoplasias Gastrointestinais/terapia , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/terapia , Neoplasias Gastrointestinais/cirurgia , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Assistência ao Paciente/normas , Guias de Prática Clínica como Assunto/normas , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirurgia
17.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(9): 840-844, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32927506

RESUMO

In patients with recurrent or metastatic gastrointestinal stromal tumor (GIST), imatinib is the mainstay treatment, which has significantly improved outcome. However, approximately half of patients who have initial respose to imatinib will develop secondary resistance within 2 years, leading to progressive disease. Available data suggest that cytoreductive surgery may be considered in patients with metastatic GIST who respond to imatinib and have relatively low tumor burden, particularly in whom a R0/R1 resection is anticipated. The evidence of benefit from surgery in patients with focal tumor progression on imatinib is limited, but after surgical resection of progressive lesions, shifting to second line therapy should be initiated. Patients with multifocal progression are not suitable for surgical intervention. In the meantime, surgery for patients treated with sunitinib is feasible, yet survival benefit remains controversial. Thus, surgery should be considered in patients with metastatic GIST whose disease responds to imatinib with a goal of performing R0/R1 resection. On a case-by-case basis, surgical intervention should be determined after careful multidisciplinary consultation to achieve safety, improvement of symptoms and long-term survival benefits.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Gastrointestinais/cirurgia , Tumores do Estroma Gastrointestinal/cirurgia , Mesilato de Imatinib/uso terapêutico , Recidiva Local de Neoplasia/cirurgia , Procedimentos Cirúrgicos de Citorredução , Progressão da Doença , Resistencia a Medicamentos Antineoplásicos , Neoplasias Gastrointestinais/tratamento farmacológico , Neoplasias Gastrointestinais/patologia , Tumores do Estroma Gastrointestinal/tratamento farmacológico , Tumores do Estroma Gastrointestinal/secundário , Humanos , Recidiva Local de Neoplasia/tratamento farmacológico , Equipe de Assistência ao Paciente , Sunitinibe/uso terapêutico , Resultado do Tratamento , Carga Tumoral
18.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(9): 845-851, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32927507

RESUMO

Gastrointestinal stromal tumor (GIST) is the most common soft tissue sarcoma in the gastrointestinal tract. Biological behavior of GIST is varied. It is very important to accurately assess the risk of recurrence and metastasis after resection of primary tumor in order to guide adjuvant therapy and predict prognosis. With increasing understanding of the biological behavior of GIST, the risk stratification criterion has undergone continuous reform and improvement since its introduction. In the early stage, clinical parameters such as tumor size and mitotic rate were formulated as risk stages, and then tumor site, tumor rupture and other factors were included to form a more accurate AFIP standard and modified NIH risk stratification. Recently, more researches have used new statistical methods such as nomogram and contour maps, which more accurately predict risk of recurrence and better guide adjuvant treatment. Thus, individualized treatment of GIST becomes possible.


Assuntos
Neoplasias Gastrointestinais/diagnóstico , Tumores do Estroma Gastrointestinal/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Medição de Risco/métodos , Terapia Combinada , Neoplasias Gastrointestinais/patologia , Neoplasias Gastrointestinais/cirurgia , Tumores do Estroma Gastrointestinal/secundário , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Nomogramas , Prognóstico
19.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(9): 861-865, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32927510

RESUMO

The therapeutic choice of duodenal gastrointestinal stromal tumor (GIST) has always been the focus of surgeons because of its special anatomy location. So far, surgery is the preferable treatment for primary duodenal GIST, including pancreaticoduodenectomy (PD) and local resection (LR). Researches reveal that the prognosis of duodenal GIST is determined by the pathologic factors of the tumor itself, and is not significantly associated with the surgical procedure. The intervention with targeted drugs such as imatinib has given the duodenal GIST more opportunities for LR. Meanwhile, the technique development of the laparoscopy combined with endoscopic surgery and robotic surgery ensures the steps of minimally invasive treatment for duodenal GIST into a new era.


Assuntos
Neoplasias Duodenais/cirurgia , Duodeno/cirurgia , Tumores do Estroma Gastrointestinal/cirurgia , Pancreaticoduodenectomia/métodos , Antineoplásicos/uso terapêutico , Terapia Combinada , Neoplasias Duodenais/patologia , Tumores do Estroma Gastrointestinal/patologia , Humanos , Mesilato de Imatinib/uso terapêutico , Procedimentos Cirúrgicos Minimamente Invasivos , Prognóstico , Procedimentos Cirúrgicos Robóticos
20.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(9): 888-895, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32927514

RESUMO

Objective: To compare the efficacy between laparoscopy and open surgery for gastric gastrointestinal stromal tumor (GIST) larger than 2 cm. Methods: A multicenter retrospective cohort study was performed. Inclusion criteria: long diameter of primary gastric GIST > 2 cm; undergoing laparoscopy or open surgery; diagnosis confirmed by postoperative pathology without distant metastasis; without preoperative targeted therapy. Clinicopathological data of 857 gastric GIST patients, including 320 in PLA General Hospital, 284 in Shanghai Renji Hospital, 175 in Wuhan Union Hospital and 78 in Tianjin Cancer Hospital, from January 2010 to May 2017 were retrospectively collected. There were 418 males and 439 females, mainly aged between 50 and 70 years old. Among 857 patients, 413 were in the laparoscopy group and 444 in the open group. The nearest neighbor matching of propensity score matching method was conducted with 1:1 matching based on tumor location and size between laparoscopy and open group to obtain samples of covariate equilibrium, and the caliper value was 0.04. The t test, χ(2) test and Wilcoxon rank test were used to compare short-term efficacy, and the Kaplan-Meier curve and log rank test were applied to compare long-term outcomes between the two groups. Results: After propensity score matching, laparoscopy group and open group both enrolled 293 cases. The baseline data, including age, gender, tumor location, tumor long diameter, NIH classification, etc. were not significantly different between the two groups (all P>0.05). Compared with the open group, the laparoscopy group had less intraoperative blood loss [<100 ml: 2.9% (155/293) vs. 36.2% (106/293), Z=-12.857, P<0.001], shorter time to postoperative feeding [(4.0±0.2) days vs. (5.3±0.9) days, t=1.505, P=0.003] and to the removal of drainage tube [(4.8±1.0) days vs. (6.5±1.0) days, t=1.847, P=0.008], and shorter postoperative hospital stay [(8.6±0.3) days vs. (10.5±0.3) days, t=4.235, P<0.001]. Subgroups analysis according to anatomical location: (1) Gastric cardia and pylorus: there were no statistically significant differences in perioperative parameters between the two groups (all P>0.05). (2) Stomach base: feeding time after surgery [(4.0±0.2) days vs. (4.5±0.2) days, t=0.512, P=0.038], drainage tube removal time [(5.1±0.4) days vs. (6.4±0.6) days, t=0.517, P=0.044], postoperative hospital stay [(8.0±0.5) days vs. (11.1±0.9) days, t=0.500, P=0.002] were all significantly shorter in the laparoscopy group as compared to the open group, while the differences in other perioperative parameters were not statistically significant (all P>0.05). (3) Lesser curvature of the stomach: the laparoscopy group had less intraoperative blood loss [<100 ml ratio: 58.1% (43/74) vs. 33.7% (25/74), Z=7.632, P=0.034], shorter gastric tube removal time [(2.7±0.2) days vs. (3.2±0.3) days, t=0.503, P=0.007], earlier postoperative passage of gas [(2.8±0.1) days vs. (3.4±0.2) days, t=0.532, P=0.030], earlier postoperative feeding [(3.6±0.2) days vs. (4.3±0.2) days, t=0.508, P=0.020], shorter drainage tube removal time [(4.2±0.4) days vs. (5.7±0.5) days, t=0.508, P=0.020] and postoperative hospital stay [(8.3±0.6) days vs. (10.7±0.3) days, t=0.502, P=0.006] as compared to the open group. (4) Great curvature of the stomach: the laparoscopy group presented less intraoperative blood loss [<100 ml ratio: 52.7% (39/74) vs. 36.5% (27/74), Z=7.681, P=0.032], earlier gastric tube removal [(2.6±0.2) days vs. (3.6±0.2) days, t=0.501, P=0.001], earlier postoperative passage of gas [(2.7±0.2) days vs. (3.4±0.2) days, t=0.501, P=0.016], earlier postoperative feeding [(3.6±0.2) days vs. (4.7±0.2) days, t=0.500, P=0.001], shorter drainage tube removal time [(4.0±0.5) days to (5.9±0.4) days, t=0.508, P=0.002] and postoperative hospital stay [(7.5±0.3) days to (9.5±0.1) days, t=0.500, P=0.001] than the open group. Subgroup analysis according to tumor size: (1) Tumor long diameter 2.0-5.0 cm: the laparoscopy group had earlier passage of gas [(2.9±0.1) days vs. (3.5±0.1) days, t=0.500, P=0.001], earlier postoperative feeding [(4.5±0.1) days vs. (5.0±0.2) days, t=0.501, P=0.013], shorter drainage tube removal time [(4.8±0.3) days vs. (6.0±0.3) days, t=0.511, P=0.008] and postoperative hospital stay [(8.1±0.4) days to (10.1±0.3) days, t=0.513, P=0.001] than the open group. (2) Tumor long diameter 5.1-10.0 cm: in the laparoscopic group, postoperative feeding time [(4.0±0.2) days vs. (4.7±0.2) days, t=0.506, P=0.015], drainage tube removal time [(4.6±0.4) days vs. (6.4±0.5)) days, t=0.501, P=0.004], postoperative hospital stay [(8.2±0.3) days vs. (10.9±0.6) days, t=0.500, P=0.001] were all shorter than those in the open group. No intraoperative and postoperative complications were observed in each group. The 5-year recurrence-free survival rates of the laparoscopy group and the open group were 95.4% and 91.6%, respectively (P=0.734), and the 5-year overall survival rates were 93.8% and 90.8% (P=0.691), respectively, and the differences were not statistically significant. Conclusions: In experienced medical centers, laparoscopic surgery for gastric GIST larger than 2 cm is safe and feasible, and can achieve comparable efficacy with open surgery. For gastric GISTs which do not locate in the greater curvature and the anterior wall of the stomach, and whose long diameter is ≤5 cm, laparoscopic surgery does not increase the risk of recurrence and metastasis, and can accelerate postoperative recovery.


Assuntos
Gastrectomia/métodos , Tumores do Estroma Gastrointestinal/cirurgia , Neoplasias Gástricas/cirurgia , Idoso , Feminino , Gastrectomia/efeitos adversos , Gastrectomia/estatística & dados numéricos , Tumores do Estroma Gastrointestinal/patologia , Humanos , Laparoscopia , Laparotomia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Resultado do Tratamento
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