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Rave TE, Guerrero MA, Christian DJ, Zuberi J. Debulking of Advanced Gastrointestinal Stromal Tumor With Peritoneal Carcinomatosis Refractory to Imatinib and Sunitinib: A Case Report. J Med Cases 2021; 12:45-48. [PMID: 34434427 PMCID: PMC8383614 DOI: 10.14740/jmc3598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/10/2020] [Indexed: 01/17/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are non-epithelial stromal tumors that arise in the gastrointestinal tract. Pharmacological treatments for GIST are tyrosine kinase inhibitors. For metastatic disease, debulking may be helpful in reducing the tumor burden, thus increasing the effectiveness of tyrosine kinase inhibitors. Debate on whether resection would benefit the patient is still present. Here is a case of a 52-year-old African American male presenting with metastatic malignant GIST with peritoneal carcinomatosis refractory to imatinib and sunitinib. Since this patient had stage IV metastasis it was ultimately decided to proceed with a therapeutic debulking procedure. For this patient, the procedure increased the effectiveness of the medication and reduced mass effect symptoms, improving quality of life.
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Affiliation(s)
- Talia E Rave
- School of Medicine, St. George's University, Grenada, West Indies.,St. Joseph's University Medical Center, 703 Main St., Paterson, NJ 07503, USA
| | - Manrique A Guerrero
- Department of Surgery, Faculty of Surgery, St. Joseph's Hospital University Medical Center, Paterson, NJ, USA
| | - Derick J Christian
- Department of Surgery, Faculty of Surgery, St. Joseph's Hospital University Medical Center, Paterson, NJ, USA
| | - Jamshed Zuberi
- Department of Surgery, Faculty of Surgery, St. Joseph's Hospital University Medical Center, Paterson, NJ, USA
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Ghantarchyan H, Daniel T, Guerrero MA, Perrone J, Hanna P, Zuberi J, Christian DJ. Decreasing the burden: An unusual GIST presentation, a case report. Int J Surg Case Rep 2020; 74:243-246. [PMID: 32896685 PMCID: PMC7484535 DOI: 10.1016/j.ijscr.2020.08.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/24/2020] [Accepted: 08/24/2020] [Indexed: 01/17/2023] Open
Abstract
GIST may be refractory to treatment with only Imatinib and Sunitinib. Surgical debulking in addition to molecular therapy for patients with severely extensive GISTs. Debulking promotes an improved response to chemotherapy, decreases symptoms of obstruction and improves pain, and increases the patient’s ability in activities of daily living. Debulking this large mass significantly reduced tumor burden and thus promoted to an overall increase in chemotherapy effectivity.
Introduction Gastrointestinal stromal tumours (GIST) are notoriously one of the most common mesenchymal tumours of the alimentary canal. Most commonly originating from the gastric stroma, they are recognized by their mass effects on the abdominal cavity. Recurrence frequently occurs with GIST and these tumours may become refractory to tyrosine kinase inhibitors (TKIs). Therefore, resection may be indicated for improved outcomes. Presentation of case We present a 52-year-old African American male with a surgical history of GIST resection with recurrence that came to the emergency room with worsening diffuse abdominal pain. The tumour was refractory to two TKIs, Imatinib and Sunitinib. Computed tomography (CT) of the abdomen and pelvis was done which showed severe metastatic disease with carcinomatosis, multiple dilated loops of small bowel in the left hemiabdomen without discrete transition point. After seventeen days on nasogastric tube, antiemetics, the patient worsened, and it was decided to go to surgery. In this report, attention is focused on the surgical approach of tumour debulking with subsequent Regorafenib therapy for decreased obstructive symptoms and improved quality of life. Conclusion This case serves as an example of the importance of surgical debulking in addition to molecular therapy for patients with severely extensive GISTs. Tumour debulking is important to decrease tumour burden, improve chemotherapeutic response and improve quality of life especially in persons refractory to pharmacological therapy.
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Affiliation(s)
- Henrik Ghantarchyan
- St. Joseph's University Medical Center, 703 Main St., Paterson, NJ, 07503, United States; St. George's University, School of Medicine, Grenada.
| | - Tyrell Daniel
- St. Joseph's University Medical Center, 703 Main St., Paterson, NJ, 07503, United States; St. George's University, School of Medicine, Grenada.
| | - Manrique A Guerrero
- Department of Surgery, St. Joseph's University Medical Center, 703 Main St., Paterson, NJ, 07503, United States.
| | - John Perrone
- Department of Surgery, St. Joseph's University Medical Center, 703 Main St., Paterson, NJ, 07503, United States.
| | - Paul Hanna
- Department of Surgery, St. Joseph's University Medical Center, 703 Main St., Paterson, NJ, 07503, United States.
| | - Jamshed Zuberi
- Department of Surgery, St. Joseph's University Medical Center, 703 Main St., Paterson, NJ, 07503, United States.
| | - Derick J Christian
- Department of Surgery, St. Joseph's University Medical Center, 703 Main St., Paterson, NJ, 07503, United States.
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Christian DJ, Khithani A, Jeyarajah DR. Making liver transection even safer: a novel use of microwave technology. Am Surg 2011; 77:417-421. [PMID: 21679548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Hepatic surgery has evolved significantly in the past decade. The current article describes the largest series of patients in United States undergoing liver resective therapy with the use of microwave technology for liver precoagulation. Glisson's capsule was incised after securing inflow and outflow control. Two antennae, 2 cm apart, connected to a 915-MHz generator, were inserted 5 cm into liver parenchyma at a 130° angle. Once the parenchyma was firm and changed its color to gray, the antennae were advanced along the line of transection. The parenchyma was divided with electrocautery. Intra- and postoperative data were analyzed. Thirty-five patients (24 men) underwent liver resections. Diseases treated were colorectal metastases (n = 9), hepatic adenoma (n = 3), gallbladder cancer (n = 3), hepatocellular carcinoma (n = 4), neuroendocrine tumor (n = 2), cholangiocarcinoma (n = 5), hemangioma (n = 2), focal nodular hyperplasia (n = 2), metastatic gastrointestinal stromal tumor (n = 1), hydatid cyst (n = 1), hepatoid carcinoma (n = 1), hepatolithiasis (n = 1), and suspected metastatic breast cancer (n = 1). Resections done were right hepatectomy (n = 19), segmental resection (n = 5), left hepatectomy (n = 4), extended right hepatectomy (n = 4), Segment IVb and Segment V resections during radical cholecystectomy (n = 2), and left lateral sectionectomy (n = 1). Median operative time for major resection was 188 and 251 minutes for minor resection. There was one postoperative mortality. Bile leak needing stenting occurred in one patient. Median blood loss for major resection was 500 mL and 265 mL for minor resection. Intraoperative transfusion was required in nine major and one minor resections. Other complications were ileus in four, deep vein thrombosis in two, intra-abdominal abscess in one, and cardiac events in two patients. Liver precoagulation with microwave technology is a novel and efficient technique with minimal morbidity and mortality for liver transection.
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Affiliation(s)
- Derick J Christian
- Department of Hepato-biliary & Pancreatic Surgery, Methodist Dallas Medical Center, Dallas, Texas 75208, USA
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Abstract
Hepatic surgery has evolved significantly in the past decade. The current article describes the largest series of patients in United States undergoing liver resective therapy with the use of microwave technology for liver precoagulation. Glisson's capsule was incised after securing inflow and outflow control. Two antennae, 2 cm apart, connected to a 915-MHz generator, were inserted 5 cm into liver parenchyma at a 130° angle. Once the parenchyma was firm and changed its color to gray, the antennae were advanced along the line of transection. The parenchyma was divided with electrocautery. Intra- and postoperative data were analyzed. Thirty-five patients (24 men) underwent liver resections. Diseases treated were colorectal metastases (n = 9), hepatic adenoma (n = 3), gallbladder cancer (n = 3), hepatocellular carcinoma (n = 4), neuroendocrine tumor (n = 2), cholangiocarcinoma (n = 5), hemangioma (n = 2), focal nodular hyperplasia (n = 2), metastatic gastrointestinal stromal tumor (n = 1), hydatid cyst (n = 1), hepatoid carcinoma (n = 1), hepatolithiasis (n = 1), and suspected metastatic breast cancer (n = 1). Resections done were right hepatectomy (n = 19), segmental resection (n = 5), left hepatectomy (n = 4), extended right hepatectomy (n = 4), Segment IVb and Segment Vresections during radical cholecystectomy (n = 2), and left lateral sectionectomy (n = 1). Median operative time for major resection was 188 and 251 minutes for minor resection. There was one postoperative mortality. Bile leak needing stenting occurred in one patient. Median blood loss for major resection was 500 mL and 265 mL for minor resection. Intraoperative transfusion was required in nine major and one minor resections. Other complications were ileus in four, deep vein thrombosis in two, intra-abdominal abscess in one, and cardiac events in two patients. Liver precoagulation with microwave technology is a novel and efficient technique with minimal morbidity and mortality for liver transection.
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Affiliation(s)
| | - Amit Khithani
- Cancer Center, Methodist Dallas Medical Center, Dallas, Texas
| | - D. Rohan Jeyarajah
- Department of Hepato-biliary & Pancreatic Surgery, Dallas, Texas
- Cancer Center, Methodist Dallas Medical Center, Dallas, Texas
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Christian DJ, Khithani A, Castro-Arreola ME, Levitan D, Jeyarajah DR. Surgical management of gastric varices and morbid obesity: a novel approach. Surg Obes Relat Dis 2010; 6:448-50. [DOI: 10.1016/j.soard.2010.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 04/15/2010] [Indexed: 12/26/2022]
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Abstract
This article summarizes the historical aspects of antireflux surgery,including the initial techniques and subsequent modifications. Appropriate patient selection is essential to the success of antireflux procedures. The authors review the diagnostic evaluation, the technical details of the procedure, and how to manage surgical failures.
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Affiliation(s)
- Derick J Christian
- Department of Surgery, University of Pennsylvania Health System, Penn Presbyterian Medical Center, 38th and Market Street Philadelphia, PA 19104, USA
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Abstract
Using soft x-ray observations of the bright new comet C/1999 S4 (LINEAR) with the Chandra x-ray observatory, we have detected x-ray line emission created by charge exchange between highly ionized solar wind minor ions and neutral gases in the comet's coma. The emission morphology was symmetrically crescent shaped and extended out to 300,000 kilometers from the nucleus. The emission spectrum contains 6 lines at 320, 400, 490, 560, 600, and 670 electron volts, attributable to electron capture and radiative deexcitation by the solar wind species C(+5), C(+6), N(+7), O(+7), and O(+8). A contemporaneous 7-day soft x-ray light curve obtained using the Extreme Ultraviolet Explorer demonstrates a large increase in the comet's emission coincident with a strong solar flare on 14 and 15 July 2000.
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Affiliation(s)
- C M Lisse
- University of Maryland, Department of Astronomy, College Park, MD 20742, USA.
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