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Yan S, Peng W, Cheng M, Zhang J, Liu T, Sheng M, Ren R, Chen Q, Gong W, Wu Y. Survival outcome of local versus radical resection for jejunoileal gastrointestinal stromal tumors: a propensity score-matched population-based analysis. Int J Colorectal Dis 2023; 38:253. [PMID: 37855869 PMCID: PMC10587263 DOI: 10.1007/s00384-023-04548-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE Survival after local resection (LR) versus radical resection (RR) has been revealed comparable for patients with rectal and duodenal gastrointestinal stromal tumors (GISTs), but is unknown for jejunoileal (JI) GISTs. This study aimed to compare the long-term survival between patients with JI GISTs who underwent LR and RR, and to find out the prognostic factors for JI GISTs. METHODS Patients diagnosed with JI GISTs in 1975-2019 were identified from Surveillance, Epidemiology, and End Results (SEER) database and grouped according to surgical modality. Propensity score matching (PSM) was performed to balance the LR and RR groups. Overall survival (OS) and disease-specific survival (DSS) were compared in the full and matched cohorts using Kaplan-Meier (KM) analysis. Subgroup sensitivity analyses were also performed. Risk factors associated with DSS were analyzed in multivariate Cox analysis following model selection. RESULTS 1107 patients diagnosed with JI GISTs were included in the study cohort. After PSM, OS and DSS were comparable in LR and RR groups. Consistently, the two groups had similar DSS in all subgroup analyses. Moreover, multivariate Cox analysis identified lymphadenectomy, older age, larger tumor size, distant metastasis, high and unknown mitotic rate, but not LR, as independent prognostic risk factors for JI GISTs. CONCLUSIONS We conducted the first population-based comparison between the effect of different surgical modes on survival for patients with JI GISTs. LR can be carried out safely without compromising oncological outcome, and should be considered as a treatment option in selected patients with JI GISTs.
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Affiliation(s)
- Shangcheng Yan
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Wei Peng
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Ming Cheng
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Soochow University, Suzhou, China
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University Hospital, Tokyo, 113-8431, Japan
| | - Jingyu Zhang
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Tianhua Liu
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Mengchao Sheng
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Rui Ren
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Qiang Chen
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Wei Gong
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yongyou Wu
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Soochow University, Suzhou, China.
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Luo W, Liu C, Han L, Zhang H, Shen C, Yin X, Zhao Z, Mu M, Jiang T, Cai Z, Zhang B. Local excision and radical excision for rectal gastrointestinal stromal tumors: a meta-analysis protocol. Front Oncol 2023; 13:1224725. [PMID: 37746251 PMCID: PMC10514207 DOI: 10.3389/fonc.2023.1224725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023] Open
Abstract
Background To date, several studies have compared the surgical and oncological outcomes of local excision (LE) and radical excision (RE) for rectal gastrointestinal stromal tumors (GISTs), but some have limited numbers of small series. This protocol outlines the planned scope and methods for a systematic review and meta-analysis that will compare the surgical and oncological outcomes of LE and RE in patients with rectal GISTs. Methods This protocol is presented in accordance with the PRISMA-P guideline. PubMed, Embase, Web of Science, Cochrane Library and Wanfang database will be systematically searched. Furthermore, reference lists of all included articles will be screened manually to add other eligible studies. We will include randomized controlled trials (RCTs) and non-randomized studies (NRS) in this study. The primary outcomes evaluated will be R0 resection rate and disease-free survival, while the secondary outcomes will contain overall survival, length of stay, tumor rupture rate and complications. Two reviewers will independently screen and select studies, extract data from the included studies, and assess the risk of bias of the included studies. Preplanned subgroup analyses and sensitivity analyses are detailed within this protocol. The strength of the body of evidence will be assessed using GRADE. Discussion This review and meta-analysis will provide a comprehensive evaluation of the current evidence concerning the application of LE and RE in patients with rectal GISTs. The findings from this review will serve as a foundation for future research and emphasize the implications for clinical practice. Systematic review registration PROSPERO (CRD42017078338), https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=387409, PROSPERO CRD42017078338.
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Affiliation(s)
- Wenjun Luo
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chunyu Liu
- Department of Pharmacy, Evidence-based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Luyin Han
- Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Haidong Zhang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chaoyong Shen
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaonan Yin
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhou Zhao
- Department of Gastrointestinal Cancer Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Mingchun Mu
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tianxiang Jiang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhaolun Cai
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bo Zhang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Brucchi F, Lauricella S, Bottero L, Faillace GG. Anal canal gastrointestinal stromal tumour (GIST). BMJ Case Rep 2023; 16:e255040. [PMID: 37028821 PMCID: PMC10083735 DOI: 10.1136/bcr-2023-255040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
SummaryGastrointestinal stromal tumours (GISTs) are malignant mesenchymal tumours that originate from the interstitial pacemaker cells of Cajal. They are particularly rare, comprising only 5% of all GISTs, and often present at an advanced stage. Treatment for these tumours is still a topic of debate due to their low incidence and insidious location. A woman in her mid-70s presented with rectal bleeding and anal discomfort. A 4.5×4 cm anal GIST was diagnosed. A local excision was performed and the patient was further treated with tyrosine kinase inhibitors. At a 6-month follow-up, the MRI showed that she was disease free. Anorectal GISTs are unusual and tend to be aggressive. Surgical resection is the first-line treatment for primary, localised GISTs. However, the appropriate surgical technique for these tumours is still a topic of debate. Further studies are needed to fully understand the oncologic behaviour of these rare neoplasms.
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Affiliation(s)
- Francesco Brucchi
- General Surgery Residency Program, University of Milan, Milan, Milano, Italy
| | - Sara Lauricella
- Department of Surgery, Ospedale Citta' di Sesto San Giovanni, Sesto San Giovanni, Lombardia, Italy
| | - Luca Bottero
- Department of Surgery, Ospedale Bassini, Cinisello Balsamo, Lombardia, Italy
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Outcomes of Local Excision Compared to Radical Excision of Rectal Gastrointestinal Stromal Tumors: A Propensity-Score Matched Analysis of the NCDB. World J Surg 2023; 47:269-277. [PMID: 36221005 DOI: 10.1007/s00268-022-06778-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) account for <1% of gastrointestinal cancers. The present study aimed to assess the outcomes of local and radical excision of non-metastatic rectal GISTs. METHODS This study was a retrospective cohort analysis of patients with non-metastatic rectal GISTs in the NCDB. Patients were divided according to the surgical approach into local and radical excision and were compared in regard to the baseline characteristics and outcomes. A propensity-score matched analysis was performed to match the two groups for baseline confounders. The main outcomes were 5-year overall survival (OS), surgical margins, hospital stay, short-term mortality, and readmission. RESULTS 228 patients (54.8% male) with rectal GISTs were included. Before matching, 127 (55.7%) patients underwent local excision and 101 (44.3%) had radical excision. Patients who underwent local excision had more cT1-T2 and low-grade GISTs whereas patients who had radical excision received more neoadjuvant systemic treatment. After matching for clinical T stage, tumor grade, and neoadjuvant systemic therapy, 52 patients were included in each group. Local excision had a significantly higher rate of positive resection margins (42.2% vs. 19.1%, p = 0.02) and a shorter hospital stay (0 vs. 3 days, p < 0.001) than radical excision. The two groups had similar mean OS (139.8 vs. 133.1 months, p = 0.52). CONCLUSIONS Local excision was associated with a significantly higher incidence of positive resection margins and shorter hospital stay, yet similar overall survival to radical excision.
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Khan SI, O’Sullivan NJ, Temperley HC, Rausa E, Mehigan BJ, McCormick P, Larkin JO, Kavanagh DO, Kelly ME. Gastrointestinal Stromal Tumours (GIST) of the Rectum: A Systematic Review and Meta-Analysis. Curr Oncol 2022; 30:416-429. [PMID: 36661683 PMCID: PMC9857930 DOI: 10.3390/curroncol30010034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/11/2022] [Accepted: 12/22/2022] [Indexed: 12/30/2022] Open
Abstract
Background: Rectal gastrointestinal stromal tumours (GISTs) have many treatment options, but uncertainty remains regarding the best treatment regimen for this rare pathology. The aim of this review is to assess the optimal management approach including timing of chemotherapy. Methods: PubMed, EMBASE, and Cochrane databases were searched for relevant articles comparing the impact of radical vs. local excision, and neoadjuvant vs. adjuvant therapy had on outcomes in the management of rectal GISTs. We specifically evaluated the influence that the aforementioned factors had on margins, recurrence, overall survival, 5-year disease-free survival, and hospital length of stay. Results: Twenty-eight studies met our predefined criteria and were included in our study, twelve of which were included in the quantitative synthesis. When comparing neoadjuvant versus adjuvant chemotherapy, our meta-analysis noted no significance in terms of margin negativity (R0) (odds ratio [OR] 2.01, 95% confidence interval [CI], 0.7−5.79, p = 0.20) or recurrence rates (OR 0.22, 95% CI, 0.02−1.91, p = 0.17). However, there was a difference in overall 5-year survival in favour of neoadjuvant therapy (OR 3.19, 95% CI, 1.37−7.40, * p = 0.007). Comparing local excision versus radical excision, our meta-analysis observed no significance in terms of overall 5-year survival (OR1.31, 95% CI, 0.81−2.12, p = 0.26), recurrence (OR 0.67, 95% CI, 0.40−1.13, p = 0.12), or 5-year disease-free survival (OR 1.10, 95% CI, 0.55−2.19, p = 0.80). There was a difference in length of hospital stay with a reduced mean length of stay in local excision group (mean difference [MD] 6.74 days less in the LE group; 95% CI, −6.92−−6.56, * p =< 0.00001) as well as a difference in R0 rates in favour of radical resection (OR 0.68, 95% CI, 0.47−0.99, * p = 0.05). Conclusion: Neoadjuvant chemotherapy is associated with improved overall 5-year survival, while local excision is associated with reduced mean length of hospital stay. Further large-volume, prospective studies are required to further define the optimal treatment regimen in this complex pathology.
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Affiliation(s)
| | - Niall J. O’Sullivan
- Department of Surgery, St James’s Hospital, D08 NHY1 Dublin, Ireland
- School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland
- Department of Surgery, Tallaght University Hospital, D24 NR0A Dublin, Ireland
| | - Hugo C. Temperley
- Department of Surgery, St James’s Hospital, D08 NHY1 Dublin, Ireland
| | - Emanuele Rausa
- Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Brian J. Mehigan
- Department of Surgery, St James’s Hospital, D08 NHY1 Dublin, Ireland
- School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland
| | - Paul McCormick
- Department of Surgery, St James’s Hospital, D08 NHY1 Dublin, Ireland
- School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland
| | - John O. Larkin
- Department of Surgery, St James’s Hospital, D08 NHY1 Dublin, Ireland
- School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland
| | - Dara O. Kavanagh
- Royal College of Surgeons, D02 YN77 Dublin, Ireland
- Department of Surgery, Tallaght University Hospital, D24 NR0A Dublin, Ireland
| | - Michael E. Kelly
- Department of Surgery, St James’s Hospital, D08 NHY1 Dublin, Ireland
- School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland
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Zhang X, Cai X, Deng Y, Wu T, Yang Q, Gao P, Zhang L, Yang X, Wang K, Lian K, Olowokure O, Mazzocca A, Chen EY, Wang W, Li Y, Yu K. Rectal gastrointestinal stromal tumor with metachronous liver metastasis demonstrated no relapse after multidisciplinary team discussion and comprehensive treatment: a case report. J Gastrointest Oncol 2022; 13:2679-2688. [PMID: 36388678 PMCID: PMC9660058 DOI: 10.21037/jgo-22-990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/17/2022] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND This study sought to explore the role and significance of multidisciplinary team (MDT) discussion and comprehensive treatment in the diagnosis and treatment of a gastrointestinal stromal tumor (GIST) with liver metastasis. For GIST patients with liver metastasis, MDT can evaluate whether the liver metastasis is resectable, so as to formulate accurate treatment goals and the best diagnosis and treatment plan. CASE DESCRIPTION A 53-year-old male patient with localized rectal GIST with metachronous liver metastasis (MLM) was admitted to Yunnan Cancer Hospital in October 2014. At the 1st visit, he was diagnosed with locally advanced rectal GIST, and a MDT discussion was held by departments of colorectal surgery, imaging, pathology and oncology. The tumor shrank after neoadjuvant targeted treatment with imatinib. A local resection of the rectal GIST was successfully performed via the anal approach. R0 resection was achieved and the function of the anal sphincter was preserved. Following the operation, oral imatinib treatment was discontinued after 2 years. The patient developed isolated liver metastasis 6 months later. After the MDT discussion by departments of colorectal surgery, hepatobiliary surgery, imaging, pathology, and oncology, R0 resection of the liver metastasis was achieved. After the operation, sunitinib was administered for 4.5 years. The patient's overall survival (OS) has reached 7.5 years. No tumor recurrence or metastasis was found in the re-examinations. The follow-up is ongoing. CONCLUSIONS Targeted therapy combined with surgery is the most suitable way to cure GIST patients with liver metastasis. More importantly, the multi-disciplinary management and the standardized diagnosis and treatment of GIST patients with liver metastasis through MDT discussion can improve the quality of life and prolong the survival of patients.
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Affiliation(s)
- Xuan Zhang
- Department of Colorectal Surgery, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xinyi Cai
- Department of Colorectal Surgery, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Youxiao Deng
- Department of Oncology, Tengchong People’s Hospital, Baoshan, China
| | - Tao Wu
- Department of Colorectal Surgery, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Quan Yang
- Department of Colorectal Surgery, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Pin Gao
- Department of Colorectal Surgery, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lingfang Zhang
- Department of Colorectal Surgery, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xudong Yang
- Department of Colorectal Surgery, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Kun Wang
- Department of Colorectal Surgery, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ke Lian
- Department of Colorectal Surgery, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Olugbenga Olowokure
- Division of Hematology/Oncology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Emerson Y. Chen
- Division of Hematology/Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Weimin Wang
- Department of Colorectal Surgery, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yunfeng Li
- Department of Colorectal Surgery, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Kun Yu
- Department of Colorectal Surgery, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
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Shigaki T, Tsukada Y, Teramura K, Hasegawa H, Ikeda K, Nishizawa Y, Sasaki T, Ito M. Trans-anal surgery with the taTME technique for rectal gastrointestinal stromal tumors: a retrospective study. Int J Colorectal Dis 2022; 37:1975-1982. [PMID: 35943579 DOI: 10.1007/s00384-022-04233-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Rectal gastrointestinal stromal tumors (GISTs) surgery is often challenging owing to the anatomical constraints of the narrow pelvis and tumor hugeness. Despite the increasing number of patients undergoing trans-anal total mesorectal excision (taTME) globally, the feasibility of trans-anal surgery with the taTME technique for rectal GISTs remains unclear. We aimed to evaluate the feasibility of trans-anal surgery with the taTME technique for rectal GISTs. METHODS Using a prospectively collected database, we retrospectively analyzed the clinical findings, surgical outcomes, pathological outcomes, urinary and anal functions, and prognoses of patients who underwent trans-anal surgery with the taTME technique for primary rectal GISTs at the National Cancer Center Hospital East from September 2014 to March 2020. RESULTS Twenty-one patients with primary rectal GISTs were included in this study. The median distance from the anal verge to the lower edge of the tumor was 40 mm (range, 15-60 mm), and the median tumor size was 59 mm (range, 11-175 mm). Moreover, seven and 14 patients underwent one-team and two-team surgeries, respectively, with curative intent. Nineteen patients (90.5%) underwent anus-preserving surgery, and the urinary tracts were preserved in all cases. Two-team surgery showed a significantly lower blood loss volume and shorter operation time than one-team surgery (58 vs. 222 mL, P = 0.017; 184 vs 356 min, P = 0.041, respectively). The pathological negative-margin resection rate was 100%. During the follow-up period, no patient developed local GIST recurrence and one (4.8%) developed distant metastasis. CONCLUSION Trans-anal surgery with the taTME technique is feasible for rectal GISTs, and two-team surgery may be more advantageous than one-team surgery in terms of operation time and blood loss.
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Affiliation(s)
- Takahiro Shigaki
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Yuichiro Tsukada
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Koichi Teramura
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Hiro Hasegawa
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Koji Ikeda
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Yuji Nishizawa
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Takeshi Sasaki
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Masaaki Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
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Qu H, Xu Z, Ren Y, Gong Z, Ju RH, Zhang F, Kang H, Xu Y, Chen X. Recent Advancements in the Treatment of Rectal Gastrointestinal Stromal Tumor: In Era of Imatinib. Cancer Manag Res 2022; 14:1141-1152. [PMID: 35321404 PMCID: PMC8934706 DOI: 10.2147/cmar.s352860] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/18/2022] [Indexed: 12/30/2022] Open
Abstract
Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumor of the gastrointestinal tract, with an annual incidence of 10–15 cases per million. However, rectal GIST has a low incidence, accounting for approximately 0.1% of all rectal tumors. The treatment of rectal GISTs is still controversial and the relative unified guidelines and consensus opinions are inadequate. Treatment is based primarily on the clinical experience of the physician. The widespread application of neoadjuvant imatinib therapy allows diversification of treatment, especially in the choice of surgical methods. Herein, we reviewed the most recent literature and summarized the new progress in rectal tumor treatment, with the aim of providing patients with more systematic and individualized therapeutic strategies.
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Affiliation(s)
- Hui Qu
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, 116023, People’s Republic of China
- Dalian Medical University, Dalian, People’s Republic of China
| | - ZhaoHui Xu
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, 116023, People’s Republic of China
- Dalian Medical University, Dalian, People’s Republic of China
| | - YanYing Ren
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, 116023, People’s Republic of China
| | - ZeZhong Gong
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, 116023, People’s Republic of China
- Dalian Medical University, Dalian, People’s Republic of China
| | - Ri Hyok Ju
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, 116023, People’s Republic of China
- Dalian Medical University, Dalian, People’s Republic of China
| | - Fan Zhang
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, 116023, People’s Republic of China
| | - HaoNan Kang
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, 116023, People’s Republic of China
- Dalian Medical University, Dalian, People’s Republic of China
| | - Yang Xu
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, 116023, People’s Republic of China
- Dalian Medical University, Dalian, People’s Republic of China
| | - Xin Chen
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, 116023, People’s Republic of China
- Correspondence: Xin Chen, Tel +86 17709872266, Email
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Reis NRP, Barbosa LER. Prognostic Factors and Management of Colorectal Gastrointestinal Stromal Tumors. JOURNAL OF COLOPROCTOLOGY 2022. [DOI: 10.1055/s-0041-1740297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Introduction The gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract. Even though it can be found in any location of the digestive tract, the colorectal GIST is rare. With this study, we aim to review the current knowledge regarding the prognosis and management of colorectal GIST.
Methods A literature search was conducted in PubMed, and 717 articles were collected. After analyzing these studies, 60 articles were selected to use in this review.
Results The mitotic index, as well as tumor size and location were identified as good discriminators of prognosis in various studies. Surgery remains the only curative therapy for potentially resectable tumors. However, even after surgical resection, some patients develop disease recurrence and metastasis, especially those with high-risk tumors. Therefore, surgical resection alone might be inadequate for the management of all colorectal GISTs. The discovery of GIST's molecular pathway led to a shift in its therapy, insofar as tyrosine kinase inhibitors became part of the treatment schemes for this tumor, revolutionizing the treatment's outcome and prognosis.
Discussion/Conclusion The controversy concerning colorectal GIST prognosis and treatment can be, in part, attributed to the limited number of studies in the literature. In this review, we gathered the most recent knowledge about the prognosis and management of GIST in this rare location and propose two algorithms for its approach. Lastly, we highlight the importance of an individualized approach in the setting of a multidisciplinary team.
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Affiliation(s)
- Nuno Rafael Pereira Reis
- Department of Surgery and Physiology, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Laura Elisabete Ribeiro Barbosa
- Department of Surgery and Physiology, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Department of General Surgery, Centro Hospitalar Universitário São João, Serviço de Cirurgia Geral, Porto, Portugal
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Wei J, Zhong J, Chen Z, Huang Q, Wei F, Wang Q, Cao J. Survival outcome of local vs. radical excision in rectal gastrointestinal stromal tumor: a SEER database analysis. BMC Surg 2022; 22:21. [PMID: 35065645 PMCID: PMC8783417 DOI: 10.1186/s12893-022-01485-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 01/12/2022] [Indexed: 12/03/2022] Open
Abstract
Background The choice of surgical strategy for patients with rectal gastrointestinal stromal tumor (GIST) remains controversial. This study aims to address whether the surgical procedure [local excision (LE) vs. radical excision (RE)] influences the survival outcomes. Methods The information of the patients recruited in this study was obtained from the Surveillance, Epidemiology, and End Results (SEER) database. A survival curve was used to evaluate the differences in cancer-specific survival (CSS). Results No significant difference was detected in the CSS between the LE and RE groups. Also, no significant differences were observed in the CSS between the two groups with respect to different T classification, N classification, tumor differentiation, tumor size, regional LN surgery, age, gender, race, chemotherapy, and radiotherapy. The T classification and age were independent prognostic factors in rectal GIST patients. Conclusions LE and RE have similar survival time after surgery, and LE could be considered as an effective surgical approach for rectal GIST.
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Liu Y, Chang W, Tang W, Wei Y, Liu T, Chen Y, Ji M, Liang F, Ren L, Xu J. The Combination of Neoadjuvant Therapy and Surgical Resection: A Safe and Effective Treatment for Rectal Gastrointestinal Stromal Tumors. Cancer Manag Res 2021; 13:4671-4678. [PMID: 34163242 PMCID: PMC8213965 DOI: 10.2147/cmar.s307426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/07/2021] [Indexed: 12/21/2022] Open
Abstract
Background Rectal gastrointestinal stromal tumors (GISTs) are rare digestive tumors. The treatment methods of rectal GISTs are diverse, while no standardized treatment was recommended. The aim of this study was to report the treatment mode of rectal GISTs in our center. Methods Patients with pathologically confirmed rectal GISTs who received neoadjuvant therapy and surgical resection were retrospectively collected. Perioperative complications and long-term prognosis were evaluated. Results From January 2010 to December 2019, 36 patients were pathologically diagnosed with primary rectal GISTs. After excluding patients who were treated with surgery or imatinib alone, 21 patients received neoadjuvant therapy and surgery was enrolled. During neoadjuvant treatment, tumors shrank significantly (6.53cm to 4.68cm, p<0.001) without toxicities over grade 2. The total postoperative complication rate was 42.9% (all grade). R0 resection was achieved in 76.2% patients. Transanal resection had advantages on anus preservation and postoperative recovery. No patients died during the follow-up period, 4 patients relapsed and the relapse-free survival was 81.0%. Conclusion The combination of neoadjuvant therapy and surgical resection was a safe and effective treatment for rectal gastrointestinal stromal tumors.
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Affiliation(s)
- Yu Liu
- Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Wenju Chang
- Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive, Shanghai, People's Republic of China
| | - Wentao Tang
- Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive, Shanghai, People's Republic of China
| | - Ye Wei
- Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive, Shanghai, People's Republic of China
| | - Tianyu Liu
- Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yijiao Chen
- Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Meiling Ji
- Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive, Shanghai, People's Republic of China
| | - Fei Liang
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Li Ren
- Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive, Shanghai, People's Republic of China
| | - Jianmin Xu
- Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive, Shanghai, People's Republic of China
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12
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Radical resection versus local excision for low rectal gastrointestinal stromal tumor: A multicenter propensity score-matched analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 47:1668-1674. [PMID: 33581967 DOI: 10.1016/j.ejso.2021.01.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/18/2021] [Accepted: 01/27/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The surgical approaches and resection extent for rectal gastrointestinal stromal tumors (GISTs) are controversial due to the low incidence of this disease. A multicenter retrospective cohort study was conducted to compare the postoperative and oncologic outcomes of local excision (LE) and radical resection (RR) in patients with low rectal GIST. PATIENTS AND METHODS The medical records of rectal GIST patients from 11 large-scale medical centers in China (January 2000-December 2019) were reviewed. All patients were divided into either the LE group or the RR group. Propensity score matching (PSM) was conducted to reduce confounders. RESULTS A total of 280 patients with low rectal GIST were enrolled. After PSM, 144 patients were included (72 in each group). The LE group showed a higher anal preservation rate (100.0% vs. 76.4%, P < 0.001), shorter operation time (77.1 ± 68.4 min vs. 159.1 ± 83.6 min, P < 0.001), fewer complications (8.3% vs. 22.2%, P = 0.021) and shorter postoperative hospital stay (4.9 ± 4.1 d vs. 10.7 ± 8.1 d, P < 0.001) than the RR group. There was no significant difference in recurrence-free survival (RFS) between the RR and LE groups among patients with tumors ≤2 cm (P = 0.220), and the RR group had a superior RFS than the LE group in patients with tumors >2 cm (P = 0.046). CONCLUSIONS LE resulted in improved postoperative outcomes and comparable oncological safety with a low rectal GIST of ≤2 cm. However, for patients with a low rectal GIST of >2 cm, RR might be a more appropriate option with better RFS.
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Seifert H, Fusaroli P, Arcidiacono PG, Braden B, Herth F, Hocke M, Larghi A, Napoleon B, Rimbas M, Ungureanu BS, Sãftoiu A, Sahai AV, Dietrich CF. Controversies in EUS: Do we need miniprobes? Endosc Ultrasound 2021; 10:246-269. [PMID: 34380805 PMCID: PMC8411553 DOI: 10.4103/eus-d-20-00252] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This is the fifth in a series of papers entitled "Controversies in EUS." In the current paper, we deal with high-resolution catheter probes, otherwise known as EUS miniprobes (EUS-MPs). The application of miniprobes for early carcinomas in the entire intestinal tract, for subepithelial lesions, and for findings in the bile duct and pancreatic duct as well as endobronchial use is critically discussed. Submucous lesions, especially in the colon, but also early carcinomas in special cases are considered the most important indications. The argument is illustrated by numerous examples.
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Affiliation(s)
- Hans Seifert
- Department of Gastroenterology, Evangelisches Krankenhaus, Oldenburg; Universitatsklinik fur Innere Medizin - Gastroneterologie, Hepatologie; Klinikum Oldenburg, Germany
| | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Bologna/Imola Hospital, Imola, Italy
| | - Paolo Giorgio Arcidiacono
- Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Barbara Braden
- Translational Gastroenterology Unit I, John Radcliffe Hospital I, Oxford, OX3 9DU, UK
| | - Felix Herth
- 2nd Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center (TLRCH), Member of the German Lung Research Foundation (DZL), University of Heidelberg, Heidelberg, Germany
| | - Michael Hocke
- Department of Medicine, Helios Klinikum Meiningen, Meiningen, Germany
| | - Alberto Larghi
- Digestive Endoscopy Unit, IRCCS Foundation University Hospital, Policlinico A. Gemelli, Rome, Italy
| | - Bertrand Napoleon
- 2nd Digestive Endoscopy Unit, HopitalPrivé J Mermoz Ramsay Générale de Santé, Lyon, France
| | - Mihai Rimbas
- Department of Gastroenterology, Colentina Clinical Hospital, Bucharest; Department of Internal Medicine, Carol Davila University of Medicine Bucharest, Romania
| | - Bogdan Silvio Ungureanu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Adrian Sãftoiu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Anand V Sahai
- Center Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Christoph F Dietrich
- Department of Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland; Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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Zhang H, Liu Q. Prognostic Indicators for Gastrointestinal Stromal Tumors: A Review. Transl Oncol 2020; 13:100812. [PMID: 32619820 PMCID: PMC7327422 DOI: 10.1016/j.tranon.2020.100812] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 02/08/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are potentially malignancies that can occur anywhere in the digestive tract. Tyrosine kinase inhibitors (TKIs) such as imatinib have proven effective since the discovery of KIT and PDGFRA. The current version of NCNN, ESMO and EURACAN guidelines recognized that the three main prognostic factors are the mitotic rate, tumor size and tumor site. In addition, tumor rupture is also recognized as an independent risk factor. However, recent evidence shows that various types of gene mutations are associated with prognosis, and influencing factors such as gastrointestinal bleeding and high Ki67 index have been associated with poor prognosis. It shows that the current risk classification is still insufficient and controversial. With the emergence of more and more lack mutation in KIT/PDGFRA GISTs (KIT/PDGFRA wild-type GISTs) or drug resistance genes, primary and secondary drug resistance problems are caused, which makes the treatment of late or metastatic GIST face challenges. Therefore, this article will review the clinicopathological characteristics of GIST, the special molecular subtypes and other factors that may affect prognosis. We will also explore reliable prognostic markers for better postoperative management and improve the prognosis of patients with GIST.
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Affiliation(s)
- Haixin Zhang
- Department of Trauma center, The First Hospital of China Medical University, Shenyang, China
| | - Qi Liu
- Department of Trauma center, The First Hospital of China Medical University, Shenyang, China.
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15
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Lussiez A, Suwanabol PA. Invited Commentary on "Radical excision versus local resection for primary rectal gastrointestinal stromal tumors. A cohort study" (Int J Surg 2020; 77:190-197). Int J Surg 2020; 78:145-146. [PMID: 32360503 DOI: 10.1016/j.ijsu.2020.04.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/22/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Alisha Lussiez
- Department of Surgery, University of Michigan, United States.
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