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Maeda C, Yamaoka Y, Shiomi A, Kagawa H, Hino H, Manabe S, Kai C, Nanishi K. Short-term and long-term outcomes after robotic radical surgery for rectal gastrointestinal stromal tumor. BMC Surg 2024; 24:141. [PMID: 38720315 PMCID: PMC11080177 DOI: 10.1186/s12893-024-02434-y] [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: 09/05/2023] [Accepted: 05/03/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The optimal approach for ensuring both complete resection and preservation of anal function in rectal gastrointestinal stromal tumor (GIST) remains unknown. The aim of this study was to clarify short-term and long-term outcomes after robotic radical surgery for rectal GIST. METHODS A total of 13 patients who underwent robotic radical surgery for rectal GIST between December 2011 and April 2022 were included. All robotic procedures were performed using a systematic approach. A supplemental video of robotic radical surgery for rectal GIST is attached. The short-term outcome was the incidence of postoperative complications during the first 30 days after surgery. Surgical outcomes were retrieved from a prospective database. Long-term outcomes, including overall survival and recurrence-free survival, were determined in all patients. RESULTS Median distance from the tumor to the anal verge was 4.0 cm. Surgical margins were negative in all patients. Two patients underwent neoadjuvant imatinib therapy. All patients underwent sphincter-preserving surgery. None underwent conversion to open or laparoscopic surgery. The incidence of postoperative Clavien-Dindo grade II and grade ≥ III complications was 7.7% and 0%, respectively. The median postoperative hospital stay was 7 days. Twelve patients (92.3%) underwent stoma closure within 5 months of the initial surgery. Median follow-up time was 76 months. The 5-year overall survival and recurrence-free survival rates were both 100%. None of the patients had recurrence. CONCLUSION Short-term and long-term outcomes after radical robotic surgery for rectal GIST were favorable. Robotic surgery might be a useful surgical approach for rectal GIST.
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Affiliation(s)
- Chikara Maeda
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Yusuke Yamaoka
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan.
| | - Akio Shiomi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Hiroyasu Kagawa
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Hitoshi Hino
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Shoichi Manabe
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Chen Kai
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Kenji Nanishi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
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Bhusal A, KC S, Yogi TN, Gupta RK, Kumar A, Khanal B, Katwal S, Neupane D, Lamichhane S, Bhagat R. Malignant rectal GIST managed with chemotherapy (Imatinib Mesylate): A case report and a comprehensive review. Radiol Case Rep 2024; 19:1424-1431. [PMID: 38292787 PMCID: PMC10827547 DOI: 10.1016/j.radcr.2023.12.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/08/2023] [Accepted: 12/23/2023] [Indexed: 02/01/2024] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors involving the gastrointestinal tract, arising from the interstitial cells of Cajal. GIST comprises about 1% of all GI tumors. Rectal GISTs are rare and comprise of approximately 5% of all GISTs and only 0.1% of rectal tumors are found to be GISTs. Rectal GISTs may be diagnosed incidentally or present with symptoms, including defecation problems, bleeding, and/or pain. We report a case of a 46-year-old male with rectal GIST metastasized to the liver and bilateral lung parenchyma managed by Imatinib Mesylate (IM) regimen. Rectal GIST although being rare, must be considered as a differential diagnosis in a patient presenting with defecatory problems with bleeding.
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Affiliation(s)
- Amrit Bhusal
- Department of Radio-diagnostics and Imaging, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
| | - Suraj KC
- Department of General Surgery, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
| | - Tek Nath Yogi
- BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
| | - Rakesh Kumar Gupta
- Department of General Surgery, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
| | - Abhijeet Kumar
- Department of General Surgery, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
| | - Bhawani Khanal
- Department of General Surgery, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
| | - Shailendra Katwal
- Department of Radiology, Dadeldhura Subregional Hospital, Dadeldhura, Nepal
| | - Durga Neupane
- Department of General Surgery, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
| | - Samikshya Lamichhane
- Department of Radio-diagnostics and Imaging, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
| | - Ranjan Bhagat
- Department of General Surgery, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
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Roets E, Ijzerman NS, Ho VKY, Desar IME, Reyners AKL, Gelderblom H, Grünhagen DJ, Van Etten B, Van Houdt WJ, Van der Graaf WTA, Steeghs N. Referral patterns of GIST patients: data from a nationwide study. Acta Oncol 2024; 63:28-34. [PMID: 38353407 DOI: 10.2340/1651-226x.2024.23722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/25/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND This study compares the characteristics, referral and treatment patterns and overall survival (OS) of gastrointestinal stromal tumor (GIST) patients treated in reference and non-reference centers in the Netherlands. PATIENTS AND METHODS This retrospective cohort study on patients diagnosed between 2016 and 2019, utilises data from the Netherlands Cancer Registry and the Dutch Nationwide Pathology Database. Patients were categorized into two groups: patients diagnosed in or referred to reference centers and patients diagnosed in non-reference centers without referral. RESULTS This study included 1,550 GIST patients with a median age of 67.0 in reference and 68.0 years in non-reference centers. Eighty-seven per cent of patients were diagnosed in non-reference centers, of which 36.5% (493/1,352) were referred to a reference center. Referral rates were higher for high-risk (62.2% [74/119]) and metastatic patients (67.2% [90/134]). Mutation analysis was performed in 96.9% and 87.6% of these cases in reference and in non-reference centers (p < 0.01), respectively. Systemic therapy was given in reference centers versus non-reference in 89.5% versus 82.0% (p < 0.01) of high-risk and in 94.1% versus 65.9% (p < 0.01) of metastatic patients, respectively. The proportion of positive resection margins and tumor rupture did not differ between reference and non-reference centers. Median OS was not reached. CONCLUSION A substantial amount of metastatic GIST patients in non-reference centers did not receive systemic treatment. This might be due to valid reasons. However, optimisation of the referral strategy of GIST patients in the Netherlands could benefit patients. Further research is needed to explore reasons for not starting systemic treatment in metastatic GIST patients.
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Affiliation(s)
- Evelyne Roets
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Nikki S Ijzerman
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Vincent K Y Ho
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Ingrid M E Desar
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anna K L Reyners
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Boudewijn Van Etten
- University of Groningen, University Medical Center Groningen, Department of Surgical Oncology and gastrointestinal surgery, Groningen, the Netherlands
| | - Winan J Van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Winette T A Van der Graaf
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Neeltje Steeghs
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
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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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Ghobrial Y, Zackria R, Chauhan S, Brockway M, Shah P, Asgeri M. A Rare Case of a Rectal Gastrointestinal Stromal Tumor (GIST) Discovered During a Routine Colonoscopy. Cureus 2023; 15:e41030. [PMID: 37519537 PMCID: PMC10373512 DOI: 10.7759/cureus.41030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
A gastrointestinal stromal tumor (GIST) is a rare malignancy, accounting for only 0.1% to 3% of all gastrointestinal (GI) malignancies. Although GISTs are the most common mesenchymal tumor of the GI tract, they are primarily found within the stomach, with rectal GISTs rarely reported. They may present with rectal bleeding, constipation, pain, or a palpable mass while some are found incidentally. The incidence of GISTs has been on the rise, possibly due to advancements in diagnostic technology. In this case report, we present a 50-year-old female who presented with intermittent constipation and rectal pain and was found to have a submucosal rectal mass during a routine diagnostic colonoscopy. Further evaluation confirmed the presence of a spindle-cell neoplasm, which was mildly cellular and showed positive expression of CD34 and CD117 on immunohistochemistry, consistent with the diagnosis of GIST of the rectum. This case report emphasizes the importance of routine colonoscopies in the early detection of neoplastic lesions of the colon and highlights the rare incidence of GISTs, their risk factors, pathogenesis, and common sites of occurrence.
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Affiliation(s)
| | - Rasiq Zackria
- Gastroenterology and Hepatology, Sunrise Health Graduate Medical Education (GME) Consortium, MountainView Hospital, Las Vegas, USA
| | | | | | - Pranati Shah
- Internal Medicine, Touro College of Osteopathic Medicine, Las Vegas, USA
| | - Mehrdad Asgeri
- Gastroenterology, Desert Regional Medical Center, Palm Springs, USA
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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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7
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Dawara SA, Naureen S, Keloth TR. Rectal Gastrointestinal Stromal Tumors. Cureus 2023; 15:e36361. [PMID: 37082488 PMCID: PMC10112820 DOI: 10.7759/cureus.36361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 04/22/2023] Open
Abstract
Rectal gastrointestinal stromal tumors (GISTs) are rare types of tumors, but the incidence is increasing, and we now know more about the pathogenesis and management of rectal GIST. The main goal is to resect the tumor with negative microscopic margins. With the development of neoadjuvant Imatinib therapy, preoperative reduction in tumor size has become possible, thus introducing the chance for anus-preserving surgery, with better quality of life. We present a case of a 55-year-old female who presented to the emergency department with complaints of bleeding per rectum, abdominal pain, and pain on defecation. A 6-cm mass was detected during the rectal examination and a biopsy confirmed the diagnosis of GIST. The patient was given neoadjuvant imatinib chemotherapy for four months followed by trans-anal resection of the mass. The procedure was done successfully, and she received further adjuvant imatinib for a course of three years. Follow-up by magnetic resonance imaging and a colonoscopy after two years showed no recurrence. The patient is living healthily and doing well.
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8
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Schattner A, Glick Y, Sher O, Pelles S. Gastrointestinal stromal tumor of the rectum. Am J Med Sci 2023; 365:e99-e101. [PMID: 36627083 DOI: 10.1016/j.amjms.2022.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/31/2022] [Accepted: 12/05/2022] [Indexed: 01/08/2023]
Affiliation(s)
- Ami Schattner
- Meuhedet HMO, Rehovot, and Faculty of Medicine, Hebrew University Hadassah Medical School, Jerusalem, Israel.
| | - Yair Glick
- Department of Imaging, Laniado Hospital, Sanz Medical Center, Netanya, Israel
| | - Osnat Sher
- Bone and Soft Tissue Pathology Service, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sharon Pelles
- Oncology Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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9
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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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10
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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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Kim M, Duarte-Chavez R, Kahaleh M. Device-assisted submucosal tunneling endoscopic resection for rectal gastrointestinal stromal tumor. Endoscopy 2022; 54:E763-E764. [PMID: 35561988 DOI: 10.1055/a-1824-4691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Marina Kim
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Rodrigo Duarte-Chavez
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Michel Kahaleh
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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12
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Yang J, Liu Y, Sun XJ, Ai ZW, Liu S. A rare rectal gastrointestinal stromal tumor with indolent biological behavior: A case study. Exp Ther Med 2022; 24:641. [PMID: 36160900 PMCID: PMC9468906 DOI: 10.3892/etm.2022.11578] [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: 05/16/2022] [Accepted: 07/27/2022] [Indexed: 11/27/2022] Open
Abstract
The overall incidence of rectal gastrointestinal stromal tumor (RGIST) has risen, but it remains a rare disease. Furthermore, tumor rupture is associated with poor prognosis. The present study reported a rare case of RGIST with indolent biological behavior. The biological behavior of this RGIST was analyzed and its malignant potential was evaluated using a guideline-based risk stratification assessment. The patient was diagnosed with a rectal tumor at the Third Affiliated Hospital of Qiqihar Medical University (Qiqihar, China) in April 2020 and a partial resection biopsy was then performed. This resection counts as a rupture. The biopsy confirmed RGIST and the patient refused further examination and treatment due to economic concerns. However, the patient survives with no tumor progression and metastasis until now, May 2022. In conclusion, based on the present case, tumor rupture in indolent RGIST is not necessarily associated with poor outcome.
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Affiliation(s)
- Jian Yang
- Department of General Surgery, The First Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang 154003, P.R. China
| | - Ying Liu
- Department of Medical Oncology, The Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, Heilongjiang 161000, P.R. China
| | - Xue-Jia Sun
- Department of Radiology, The Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, Heilongjiang 161000, P.R. China
| | - Zhong-Wei Ai
- Pathology Center, Qiqihar Medical University, Qiqihar, Heilongjiang 161003, P.R. China
| | - Shi Liu
- Central Laboratory, The Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, Heilongjiang 161000, P.R. China
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13
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14
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Connelly TM, Clancy C, Hu S, Steele SR, Kessler H. A Low rectal GIST. BMJ Case Rep 2022; 15:e248505. [PMID: 35288433 PMCID: PMC8921934 DOI: 10.1136/bcr-2021-248505] [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] [Accepted: 02/11/2022] [Indexed: 11/04/2022] Open
Abstract
A man in his 70s presented with narrowing of his stool calibre and a palpable mass on rectal examination. Colonoscopy revealed a submucosal bulge without a mucosal lesion. CT and MRI demonstrated an 8×5.4×7 cm mass in lower rectum. Biopsy of the mass confirmed a rectal gastrointestinal stromal tumour (GIST). It was moderately sensitive to neoadjuvant imatinib and radiotherapy, which slightly downsized the tumour. He required abdominal perineal resection with curative intent. Uncommonly found in the rectum, when located here, GISTs are typically aggressive and are a rare cause of stool calibre narrowing. Rectal GISTs should be considered in patients presenting with this symptom.
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Affiliation(s)
- Tara M Connelly
- Colorectal Surgery, Cleveland Clinic Main Campus Hospital, Cleveland, Ohio, USA
| | - Cillian Clancy
- Colorectal Surgery, Cleveland Clinic Main Campus Hospital, Cleveland, Ohio, USA
| | - Shaomin Hu
- Department of GI/Liver Pathology, Cleveland Clinic Main Campus Hospital, Cleveland, Ohio, USA
| | - Scott R Steele
- Colorectal Surgery, Cleveland Clinic Main Campus Hospital, Cleveland, Ohio, USA
| | - Hermann Kessler
- Colorectal Surgery, Cleveland Clinic Main Campus Hospital, Cleveland, Ohio, USA
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15
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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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16
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Karthikeyan M, Kolandasamy C, Naganath Babu OL. Malignant Gastrointestinal Stromal Tumor of Rectum: A Case Report and Review of Literature. Surg J (N Y) 2022; 8:e60-e64. [PMID: 35187230 PMCID: PMC8850004 DOI: 10.1055/s-0042-1742778] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/22/2021] [Indexed: 11/07/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are rare tumors of the gastrointestinal tract accounting for less than 1% of all gut tumors. GISTs occurring in the rectum are extremely rare and these usually present at an advanced stage compared with other sites. We report a case of a middle-aged female who presented with features of anemia and subacute obstruction due to a large rectal tumor and underwent abdominoperineal resection. The histopathological examination confirmed the diagnosis of high-grade malignant GIST with multiple lymph nodal metastasis. She was started on adjuvant imatinib therapy and is on follow-up without any evidence of recurrence. The authors conclude that GIST must be included in the differential diagnosis of a rectal tumor. Diagnosis is established by biopsy and immunohistochemistry studies. Surgical resection with histological negative margins is the standard curative treatment. Adjuvant targeted therapy can reduce long-term recurrence in high-risk cases.
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Affiliation(s)
- Mohan Karthikeyan
- Institute of Surgical Gastroenterology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - Chinnusamy Kolandasamy
- Institute of Surgical Gastroenterology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - Obla L Naganath Babu
- Institute of Surgical Gastroenterology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
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17
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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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18
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Surgical Outcomes of Rectal Gastrointestinal Stromal Tumor in the Era of Imatinib. J Gastrointest Surg 2021; 25:2963-2965. [PMID: 33948860 DOI: 10.1007/s11605-021-05017-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/15/2021] [Indexed: 01/31/2023]
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19
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Adesunkanmi AO, Olasehinde O, Ndegbu CU, Odunafolabi TA, Mustapha B, Lawal AO, Olorunsola IS. Rectal gastrointestinal stromal tumor: an unusual presentation of an uncommon pathology (a case report). Pan Afr Med J 2021; 39:234. [PMID: 34659607 PMCID: PMC8498667 DOI: 10.11604/pamj.2021.39.234.26727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 08/10/2021] [Indexed: 11/11/2022] Open
Abstract
Gastrointestinal stromal tumours (GIST) are a rare form of neoplasm. The stomach is the commonest location while gastrointestinal bleeding and pain are the usual presentations. Rectal GIST has been reported in literature as a rare occurrence. We report the rare case of a 37-year-old man who presented with large bowel obstruction and acute urinary retention arising from a rectal GIST. Radiological investigations showed features in keeping with intestinal obstruction. He had a divided colostomy and tumour debulking. Histology of tumour revealed a rectal GIST and immunohistochemical staining was positive for CD34 and CD117. Postoperatively Imatinib was commenced and patient did well. We report this case to highlight the unusual symptoms that may arise from a rare pathology like rectal GIST and the need to consider an alternative diagnosis-such as GIST, in a young adult presenting with large bowel obstruction in the absence of risk factors for bowel adenocarcinoma.
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Affiliation(s)
| | - Olalekan Olasehinde
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.,Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Chinedu Udochukwu Ndegbu
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | | | - Babatunde Mustapha
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Adedayo Olaitan Lawal
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Ifeoluwa Seun Olorunsola
- Department of Morbid Anatomy and Forensic Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
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20
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Cheong JY, Kim JS, Kim J. Surgery is like a box of chocolate. You never know what you're gonna get: a fibrous calcified pelvic mass. ANZ J Surg 2021; 92:923-924. [PMID: 34553827 DOI: 10.1111/ans.17207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Ju Yong Cheong
- Department of Colorectal Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Jeong Sub Kim
- Department of Colorectal Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Jin Kim
- Department of Colorectal Surgery, Korea University Anam Hospital, Seoul, South Korea
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21
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Popovici RM, Cărăuleanu A, Costea CF, Florea ID, Scripcariu DV, Mogoş RA, Cheaito A, Tănase AE, Haba RM, Grigore M. Rare retroperitoneal conditions that mimic uterine myoma. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 61:7-14. [PMID: 32747890 PMCID: PMC7728116 DOI: 10.47162/rjme.61.1.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The most frequent tumoral condition of the uterus is represented by uterine myoma. The diagnosis, in most cases, is established by clinical examination and ultrasound scan. Nevertheless, there are rare cases, in which the surgical findings reveal a retroperitoneal tumor instead of a uterine myoma. These could be represented by schwannomas or Castleman disease. The schwannomas are rarely malignant and arise from the Schwann cells of nerve fibers. These tumors are frequently found at the level of the head, neck and mediastinum and rarely in the pelvis. Generally, schwannomas localized at retroperitoneal level are asymptomatic and with a very slow growth rate. The treatment consists in complete surgical resection. The recurrence rate is low and, generally, the prognosis is good. The Castleman disease is considered a rare entity, but it should be always taken into consideration when it comes to a differential diagnosis in a young patient who presents a retroperitoneal mass at imagery exams. The condition affects the lymphatic system and is characterized by a hyperplasia of the lymph nodes, sometimes associated with herpes virus infection. The clinical picture is often non-specific; the pain may be the only symptom. The imaging methods are not always conclusive for the final positive diagnosis and the histopathological examination is always necessary. Pelvic Castleman disease can be misdiagnosed as myoma or an adnexal tumor. In this article, we review the present knowledge regarding the pathogenesis, pathology and management of these rare retroperitoneal tumors. Both conditions, when located in pelvis must be taken into consideration in the differential diagnosis of uterine myomas, especially in the pedunculated form.
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Affiliation(s)
- Răzvan Mihai Popovici
- Department of Ophthalmology, Department of Obstetrics and Gynecology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania; ,
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22
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Andrew D, Shyam K, Johny J, Jose R. Middle-aged patient with haematochezia and anaemia presenting with rectal GIST. BMJ Case Rep 2021; 14:14/4/e240872. [PMID: 33853818 PMCID: PMC8054058 DOI: 10.1136/bcr-2020-240872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Dhilip Andrew
- Radiology, St John's Medical College Hospital, Bangalore, India
| | - Karthik Shyam
- Radiology, St John's Medical College Hospital, Bangalore, India
| | - Jovis Johny
- Radiology, St John's Medical College Hospital, Bangalore, India
| | - Rini Jose
- Radiology, St John's Medical College Hospital, Bangalore, India
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23
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Li C, Wu H, Li H, Wang Q, Li Y, Gao ZD, Yang XD, Ye YJ, Jiang KW. Different Medical Features and Strategies of Large Rectal Gastrointestinal Stromal Tumor: A Multi-Central Pooling Analysis. Cancer Manag Res 2021; 13:1591-1600. [PMID: 33628049 PMCID: PMC7898204 DOI: 10.2147/cmar.s291269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/13/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose The rectum is a rare site for gastrointestinal stromal tumors (GISTs). Tumors in this critical anatomical site are prone to develop local recurrence, and this occurs at a high level even in low-risk tumors. Previous studies found that high-risk was the most common category in rectal gastrointestinal stromal tumors (RGISTs), and size was the most important factor affecting the long-term prognosis. We aimed to find out the most influential factor on clinical outcomes, and describe demographics, oncological differences, and surgical procedures in patients with poor prognosis. Patients and Methods Data on consecutive patients with RGIST, who were diagnosed at Peking University People’s Hospital, Shandong Province Hospital, and The First Affiliated Hospital of Shandong First Medical University from 2010 to 2020, were retrospectively evaluated. Further, a literature search was conducted by retrieving data from PubMed, EMBASE, and the Cochrane Library databases from inception up to March 20, 2020. Results In all, 50 patients were diagnosed with RGIST at three medical centers, and 86 published records were finally included in the literature review. Combined analysis of the whole individual patient data showed that 5.5 cm was deemed an appropriate cut-off value for L-RGIST, and that patients usually showed a male predominance (67.59%), younger age at onset (56.61 years), higher operative difficulty, and poorer prognosis. Conclusion Separation of patients with large RGIST from general patients may contribute to the recognition of the oncological characteristics and clinical management of this rare type of tumor.
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Affiliation(s)
- Chen Li
- Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, People's Republic of China
| | - Hao Wu
- Department of Gastroenterological Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Han Li
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong Province, People's Republic of China
| | - Quan Wang
- Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, People's Republic of China
| | - Yang Li
- Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, People's Republic of China
| | - Zhi-Dong Gao
- Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, People's Republic of China
| | - Xiao-Dong Yang
- Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, People's Republic of China
| | - Ying-Jiang Ye
- Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, People's Republic of China
| | - Ke-Wei Jiang
- Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, People's Republic of China
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24
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Qin X, Li C, Yang Z, Guo W, Guo H, Chen C, Huang R, Zhang D, Wang H, Wang H. Transsacrococcygeal approach in rectal gastrointestinal stromal tumour resection: 10-year experience at a single centre. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:341. [PMID: 33708968 PMCID: PMC7944327 DOI: 10.21037/atm-20-8204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background The transsacrococcygeal (TSC) approach in rectal gastrointestinal stromal tumour (GIST) resection is clinically challenging and controversial, and we evaluated its value in the present study. Methods We enrolled patients who underwent rectal GIST resection by the TSC approach during 2008–2018. The clinicopathological index, surgical outcome, and prognosis were analysed. Prognostic information was obtained from medical records and follow-up data. Anal function was evaluated by the low anterior resection syndrome (LARS) score. Results Among 88 rectal GIST patients over the 10-year study period, 17 who underwent the TSC approach were analysed. The median age was 55 (range, 26–73) years. In total, 15 patients received preoperative imatinib neoadjuvant therapy for 232 (30–690) days. The tumours were exogenous in 14 patients and intramural in 3 patients. The mean initial tumour size and preoperative tumour size were 6.4±2.2 and 4.2±1.7 cm, respectively. The operative time and blood loss were 130.2±47.4 min and 44.6±36.0 mL, respectively. Of the 17 patients 7 had postoperative complications (within 30 days postoperatively), and the complications of 5 patients were cured by conservative treatment. Only 1 patient was lost to follow-up, and the others had a good oncological prognosis at recent follow-up evaluations. All patients had LARS scores ≤9 points at 1 year after the operation. Conclusions The TSC approach can result in a good oncological prognosis, usually does not affect anal function, and is particularly suitable for exogenous middle and low rectal GISTs. However, it might cause some controlled complications. Hence, careful patient selection is necessary for this operation.
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Affiliation(s)
- Xiusen Qin
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Supported by National Key Clinical Discipline, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chuangkun Li
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Supported by National Key Clinical Discipline, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zifeng Yang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Supported by National Key Clinical Discipline, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wentai Guo
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Supported by National Key Clinical Discipline, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huili Guo
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Supported by National Key Clinical Discipline, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chun Chen
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Supported by National Key Clinical Discipline, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rongkang Huang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Supported by National Key Clinical Discipline, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Di Zhang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Supported by National Key Clinical Discipline, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huaiming Wang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Supported by National Key Clinical Discipline, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hui Wang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Supported by National Key Clinical Discipline, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Rivera AKU, Jabiles AG, Passiuri IC, Leon EG, Quiroga MG, Baca RC, Figueroa JE, Rosillo NP, Meza EP. Gastrointestinal stromal tumour of the rectum and intestinal obstruction: case report. Ecancermedicalscience 2020; 14:1139. [PMID: 33281931 PMCID: PMC7685769 DOI: 10.3332/ecancer.2020.1139] [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: 06/26/2020] [Indexed: 12/12/2022] Open
Abstract
We report the case of a 75-year-old female patient with a big tumour in the lower rectum with intestinal obstruction and lower gastrointestinal bleeding history who underwent a tumour biopsy under laparotomy and end colostomy at another hospital in Peru. She came to our institution for clinical evaluation with a pathology result of a rectal gastrointestinal stromal tumour. An extra elevator abdominoperineal resection was performed with tumour-free margins. The histology confirmed a high-grade (G2) rectal gastrointestinal stromal tumour with a mitotic index of 27/50. DOC-1 (+) and CD117 (+) in immunohistochemistry. Genomic DNA was extracted from the paraffin-fixed tumour sample, and c.1504_1509dupGCCTAT (p.Ala502_Tyr503dup) mutation was detected in exon 9 of the KIT gene. Imatinib 400 mg per day for 3 years was indicated as adjuvant treatment. Currently, she has a disease-free survival of 12 months.
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Affiliation(s)
| | | | - Ivan Chavez Passiuri
- Department of Abdominal Surgery at National Cancer Institute (INEN), Lima 34, Peru
| | - Elica Garcia Leon
- Department of Medical Oncology at Regional Hospital of Lambayeque, Lambayeque, Peru
| | | | - Renier Cruz Baca
- Fellow of Oncological Pathology at National Cancer Institute (INEN), Lima 34, Peru
| | | | | | - Eduardo Payet Meza
- Department of Abdominal Surgery at National Cancer Institute (INEN), Lima 34, Peru
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26
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Romain B, Delhorme JB, Manceau G, Lefevre JH, Tresallet C, Mariani P, Iannelli A, Rouanet P, Piessen G, Brigand C. Is nonanatomic rectal resection a valid therapeutic option for rectal gastrointestinal stromal tumors? A proposed decision algorithm. J Surg Oncol 2020; 122:1639-1646. [PMID: 33184896 DOI: 10.1002/jso.26215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/26/2020] [Accepted: 09/01/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVES The best surgical approach to rectal gastrointestinal stromal tumors (GISTs) is still debated, and both nonanatomic rectal resection (NARR) and anatomic rectal resection (ARR) are applied. The aim of this study was to evaluate the feasibility and oncological outcomes of NARR and ARR for rectal GISTs (R-GISTs). METHODS Through a large French multicentre retrospective study, 35 patients were treated for R-GIST between 2001 and 2013. Patients who underwent NARR and ARR were compared. RESULTS There were 23 (65.7%) patients in group ARR and 12 (34.3%) in group NARR. Significantly more patients in the group with ARR had a neoadjuvant treatment (86%) with tyrosine kinase inhibitor (TKI) (imatinib) compared to those with NARR (25%) (p < .01). The median preoperative tumor size was significantly different between the groups without and with neoadjuvant TKI: 30 ± 23 mm versus 64 ± 44.4 mm, respectively (p < .001). Overall postoperative morbidity was 20% (n = 7) (26% for ARR vs. 8% for NARR; p = .4). After a median follow-up of 60.2 (3.2-164.3) months, the 5-year disease-free survival rates were 79.5% (confidence interval [CI] 95%: 54-100) for the NARR group and 68% (CI 95%: 46.4-89.7) for the ARR group (p = .697), respectively. CONCLUSION The use of NARR for small R-GIST's does not seem to impair the oncological prognosis.
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Affiliation(s)
- Benoit Romain
- Department of Digestive Surgery, Strasbourg University, Strasbourg, France
| | | | - Gilles Manceau
- Department of Digestive Surgery, Hôpital Pitié-Salpêtrière, Paris, France
| | | | | | - Pascale Mariani
- Department of Digestive Surgery, Institut Curie, Paris, France
| | - Antonio Iannelli
- Department of Digestive Surgery, Hôpital Archet 2 CHU de Nice, France
| | - Philippe Rouanet
- Department of Digestive Surgery, CLCC Val D'Aurelle, Montpellier, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Université de Lille, Lille, France
| | - Cécile Brigand
- Department of Digestive Surgery, Strasbourg University, Strasbourg, France
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Rectal GIST - A review. An invited commentary on “Clinical outcomes of different therapeutic modalities for rectal gastrointestinal stromal tumor: Summary of 14-year clinical experience in a single center--Retrospective cohort study”. Int J Surg 2020; 77:116. [DOI: 10.1016/j.ijsu.2020.03.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 03/22/2020] [Indexed: 12/19/2022]
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Guo W, Yang Z, Wei Y, Qin X, Li C, Huang R, Hu M, Zeng Z, Wang H, Wang H. Radical excision versus local resection for primary rectal gastrointestinal stromal tumors. Cohort Study. Int J Surg 2020; 77:190-197. [PMID: 32278104 DOI: 10.1016/j.ijsu.2020.03.068] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/08/2020] [Accepted: 03/27/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Rectal gastrointestinal stromal tumor (GIST) is a rare digestive disease that originates in mesenchymal tissues and has malignant tendencies. At present, no standard treatment has been developed, and surgical approaches and the resection scope for rectal GISTs are controversial. METHODS The clinical, surgical, pathological and prognosis data of patients with primary rectal GIST in our center from January 2008 to January 2019 were retrospectively collected. The patients were divided into the radical excision (RE) and local resection (LR) groups. RESULTS A total of 537 GIST cases were collected, and 64 patients with primary rectal GIST were included in this study, including 25 cases in the RE group and 39 cases in the LR group. Tumor size (p = 0.013), distance from the anus (p = 0.038), National Institutes of Health (NIH) criteria (p = 0.001), preoperative adjuvant therapy (p = 0.016), postoperative adjuvant therapy (p = 0.028), blood loss (p = 0.048), operative time (p = 0.020) and the duration of hospitalization (p = 0.021) were statistically different between these 2 groups. The mean overall follow-up time was 46 months (range, 1-122 months). Disease recurrence was observed in 12 patients. No statistical differences were observed in 5-year disease-free survival (DFS) (93.3% vs 92.6%, p = 0.952) or overall survival (OS) (90.0% vs 91.6%, p = 0.832) between the RE group and the LR group. CONCLUSION Our study showed that LR has a similar prognosis to that of RE with respect to DFS and OS. For appropriate cases, LR has the advantages of a short operative time, less bleeding, and a quick recovery. Especially when combined with neoadjuvant therapy, LR can also achieve better perioperative efficacy. Therefore, LR is an effective method for resection of rectal GISTs and warrants clinical endorsement.
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Affiliation(s)
- Wentai Guo
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510655, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510655, China.
| | - Zifeng Yang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510655, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510655, China.
| | - Yingqi Wei
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510655, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510655, China.
| | - Xiusen Qin
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510655, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510655, China.
| | - Chuangkun Li
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510655, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510655, China.
| | - Rongkang Huang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510655, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510655, China.
| | - Minhui Hu
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510655, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510655, China.
| | - Zhantao Zeng
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510655, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510655, China.
| | - Huaiming Wang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510655, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510655, China.
| | - Hui Wang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510655, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510655, China.
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Yang Z, Guo W, Huang R, Hu M, Wang H, Wang H. Transanal versus nontransanal surgery for the treatment of primary rectal gastrointestinal stromal tumors: a 10-year experience in a high-volume center. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:201. [PMID: 32309348 PMCID: PMC7154442 DOI: 10.21037/atm.2020.01.55] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background Rectal gastrointestinal stromal tumor (GIST) is a rare digestive disease that has a distinct malignant tendency compared to that of gastric-derived GIST. At present, there is still no standard, and the surgical approach to rectal GIST is controversial. Methods The clinicopathological data and prognosis of rectal GIST patients admitted to the Sixth Affiliated Hospital of Sun Yat-sen University from 1998.01.01 to 2018.12.31 were collected retrospectively. All cases were divided into either the transanal (TA) group or the nontransanal (NTA) group. Results A total of 537 GIST cases were treated in 10 years, including 82 rectal GIST cases (64 cases underwent surgical resection, including 29 cases in the TA group and 35 cases in the NTA group). Preoperative neoadjuvant therapy (P=0.003), postoperative adjuvant therapy (P=0.017), operative time (P=0.013), blood loss (P=0.038), anus-preserver (P=0.048), 30-day complication rate (P=0.000), time to flatus (P=0.036), hospital stays (P=0.011), distance from the anus (P=0.047), tumor size (P=0.002), mitotic count (P=0.035) and National Institutes of Health (NIH) criteria (P=0.000) were significantly different between these two groups (all P<0.05). The median follow-up time was 41 (range, 1–122) months. Twelve patients had recurrence and metastasis, and 4 patients died. The 5-year disease-free survival (DFS) and overall survival (OS) were 74.4% and 91.2%, respectively, in the whole group. There were no statistically significant differences between the TA group and the NTA group at 5-year DFS (81.3% vs. 79.0%, P=0.243) and OS (88.7% vs. 93.3%, P=0.308). Conclusions In the treatment of rectal GIST, TA resection has a minimally invasive effect, less postoperative complications, high anal sphincter preservation rate, and R0 resection rate and a better prognosis. How to improve the proportion of neoadjuvant therapy and choose the appropriate cases for TA surgery is still a challenge.
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Affiliation(s)
- Zifeng Yang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China.,Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Supported by National Key Clinical Discipline, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China
| | - Wentai Guo
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China.,Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Supported by National Key Clinical Discipline, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China
| | - Rongkang Huang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China.,Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Supported by National Key Clinical Discipline, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China
| | - Minhui Hu
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China.,Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Supported by National Key Clinical Discipline, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China
| | - Huaiming Wang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China.,Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Supported by National Key Clinical Discipline, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China
| | - Hui Wang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China.,Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Supported by National Key Clinical Discipline, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China
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Stuart E, Banerjee S, de la Torre J, Wang Y, Scherzer N, Burgoyne AM, Parry L, Fanta PT, Ramamoorthy S, Sicklick JK. Frequent rectal gastrointestinal stromal tumor recurrences in the imatinib era: Retrospective analysis of an International Patient Registry. J Surg Oncol 2019; 120:715-721. [PMID: 31297829 PMCID: PMC6699886 DOI: 10.1002/jso.25621] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 06/22/2019] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Rectal gastrointestinal stromal tumor (GIST) is rare and comprises about 3% of GIST. METHODS Registry data was collected by the Life Raft Group June 1976 to November 2017. All patients had a histologic GIST diagnosis. Demographic, clinicopathologic, and clinical outcome data were patient reported. Recurrence-free survival (RFS) was analyzed using the Kaplan-Meier method and Cox regression analysis. RESULTS Of 1798 patients in the database, 48 had localized rectal GIST (2.7%). Patients were frequently male (58.3%) and non-Hispanic whites (58.3%). Median age at diagnosis was 52 years. Most patients (77%) were diagnosed in the imatinib era (2001 to current). Over half (54.2%) of the cohort had mutation testing and all profiled tumors possessed KIT mutations (exon 9: 7.7%, exon 11: 88.5%, and exon 13: 3.8%). Most evaluable patients (26/28; 92.9%) had high-risk disease (modified NIH criteria) and nearly all patients (95.8%) received imatinib. Median follow-up was 8.8 years (range, 0.3-30.7) and overall RFS was 8.0 years (95% CI, 2.9-13.1). Thirty-two percent (12/37) of patients in the post-imatinib era developed recurrent disease. Diagnosis in the imatinib era was associated with improved RFS (HR = 0.22, 95% CI, 0.08-0.62; P = .004) in the multivariable model. CONCLUSION We find that disease recurrence remains prevalent in one-third of patients treated during the imatinib-era.
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Affiliation(s)
- Emelia Stuart
- School of Medicine, University of California, San Diego, La Jolla, CA
| | - Sudeep Banerjee
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, San Diego, La Jolla, CA
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jorge de la Torre
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, San Diego, La Jolla, CA
| | - Yu Wang
- Life Raft Group, Wayne, NJ, United States
| | | | - Adam M. Burgoyne
- School of Medicine, University of California, San Diego, La Jolla, CA
- Division of Hematology Oncology, Department of Medicine, Moores Cancer Center, University of California, San Diego, La Jolla, CA
| | - Lisa Parry
- School of Medicine, University of California, San Diego, La Jolla, CA
- Division of Colorectal Surgery, Department of Surgery, Moores Cancer Center, University of California, San Diego, La Jolla, CA
| | - Paul T. Fanta
- School of Medicine, University of California, San Diego, La Jolla, CA
- Division of Hematology Oncology, Department of Medicine, Moores Cancer Center, University of California, San Diego, La Jolla, CA
| | - Sonia Ramamoorthy
- School of Medicine, University of California, San Diego, La Jolla, CA
- Division of Colorectal Surgery, Department of Surgery, Moores Cancer Center, University of California, San Diego, La Jolla, CA
| | - Jason K. Sicklick
- School of Medicine, University of California, San Diego, La Jolla, CA
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, San Diego, La Jolla, CA
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Liu Z, Wu S, Gou S, Li Y, Wu H, Li Y. A Population-Based Study of the Incidence and Survival of Anorectal Gastrointestinal Stromal Tumor. Med Sci Monit 2019; 25:5408-5417. [PMID: 31326976 PMCID: PMC6668496 DOI: 10.12659/msm.915967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Gastrointestinal stromal tumor (GIST) is the most common type of primary gastrointestinal mesenchymal tumor, but GISTs arising in the anus and rectum are rare. This study aimed to undertake a population-based analysis of the incidence, patient demographics, and survival of patients with anorectal GIST compared with patients with GIST arising from other sites based on the Surveillance, Epidemiology, and End Results (SEER) Program database. Material/Methods The SEER database was used to identify all patients diagnosed with GIST and patients diagnosed with anorectal GIST from 2000 to 2015. The incidence of GIST, baseline clinical and demographic data, tumor stage, and patient survival data were analyzed, including overall survival (OS) and cancer-specific survival (CSS). Results A total of 277 patients with anorectal GIST were identified, with an incidence of 0.018 per 100,000. The incidence of GIST arising from other sites was 0.719 per 100,000. The median age at diagnosis for anorectal GIST was 57.5 years (range, 26–92 years), median tumor size was 6.55 cm (range, 0.6–20 cm), and surgery, but not chemotherapy, improved OS and CSS. Patients with anorectal GIST had a mean 1-year, 3-year, 5-year, and 10-year OS of 91.1%, 82.5%, 75.2%, and 58.5%, respectively. Patients with GIST arising at other sites had a mean 1-year, 3-year, 5-year, and 10-year OS of 88.3%, 76.4%, 66.5%, and 46.8%, respectively. Conclusions Anorectal GIST is a rare tumor that has a better outcome compared with GISTs arising at other sites in the gastrointestinal tract.
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Affiliation(s)
- Zhiqiang Liu
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Shihong Wu
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China, China (mainland)
| | - Shanmiao Gou
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China, China (mainland)
| | - Yang Li
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Heshui Wu
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Yongfeng Li
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
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Wejih DM, Leila GE, Ali CM, Ramzi N, Ibtissem B, Chadli D. Rectal stromal tumor with an exceptional liver and bone metastatic locations. Pan Afr Med J 2019; 32:133. [PMID: 31303906 PMCID: PMC6607269 DOI: 10.11604/pamj.2019.32.133.17985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/21/2019] [Indexed: 01/18/2023] Open
Abstract
Gastrointestinal stromal tumours (GIST) are rare mesenchymal tumours which represent 1% to 3% of gastrointestinal neoplasm. Rectal location of GIST is extremely rare reaching 5% of GIST and only 0.1% of rectal tumours. They usually metastases to the liver (65%) and exceptionally to the bone (3%). We reported a case of rectal stromal tumour with an exceptional metastasis located in the rib. A 40-year-old man who presented with pelvic pain, associated with rectal syndrome, rectal bleeding and subocclusive episodes. Physical examination objectified a tough, budding rectal mass, with a smooth wall, localized 3cm above of anal margin. A Thoraco-abdominal computed tomography showed a large heterogeneous tissue mass, taking the whole pelvis, coming from the right-side wall of the rectum of 17.3 x 14cm. It was associated with liver and bone secondary locations. Biopsies confirmed the secondary locations of an intermediate risk GIST. Immunohistochemical study showed an overexpression of c-kit protein (CD117) and Dog1. Imatinib was prescribed to reduce the tumour size. Stromal metastatic rectal tumours in bone level are extremely rare conditions. The diagnosis is confirmed by histological examination with immune histochemical analysis. The prognosis remains poor in metastatic forms but it has been improved since the introduction of Imatinib.
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Affiliation(s)
| | | | | | - Nouira Ramzi
- Surgery B Department, Charles Nicolle Hospital, Tunis, Tunisia
| | | | - Dziri Chadli
- Surgery B Department, Charles Nicolle Hospital, Tunis, Tunisia
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Lee MH, Yang HY. Complete radiographic response of a rectal gastrointestinal stromal tumor to imatinib mesylate. JOURNAL OF CANCER RESEARCH AND PRACTICE 2019. [DOI: 10.4103/jcrp.jcrp_4_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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