Ann Surg Treat Res.  2014 Dec;87(6):298-303. 10.4174/astr.2014.87.6.298.

Gastrointestinal stromal tumors (GISTs) of the stomach: a multicenter, retrospective study of curatively resected gastric GISTs

• Kim IH
• Kim IH
• Kwak SG
• Kim SW
• Chae HD

• KMID: 2167085
• DOI: http://doi.org/10.4174/astr.2014.87.6.298

Abstract

PURPOSE
The standard treatment for primary localized gastric gastrointestinal stromal tumor (GIST) is surgical resection. The clinical behavior of gastric GIST after surgical resection is extremely variable. We conducted a multicenter, retrospective study of gastric GISTs patients who underwent curative surgical resection to evaluate clinical features and the prognosis of surgically treated gastric GISTs.
METHODS
We performed a retrospective study on 406 consecutive patients who underwent curative resections for localized gastric GIST at four university hospitals in Daegu, Korea, between March 1998 and March 2012. The retrospectively collected medical records were reviewed with respect to clinical parameters including age, gender, tumor location, surgical approach, and recurrence.
RESULTS
There were 406 patients: 157 males (38.7%) and 249 females (61.3%), with a mean age of 60.8 +/- 10.8 (standard deviation) years. The mean tumor size was 4.9 cm (range, 0.3-29 cm). Curative surgical resection was performed in all patients without tumor rupture or spillage. Laparoscopic wedge resections were performed in 156 patients (38.4%) and open resections in 250 patients (61.6%). The tumor size of the laparoscopic wedge resection group was smaller than that of open resection group (3.45 cm vs. 5.46 cm; P < 0.001). There were 11 recurrent cases (2.7%). No recurrence was observed in patients who underwent laparoscopic wedge resections.
CONCLUSION
Gastric GISTs had a low recurrence rate after curative resection in our series. Laparoscopic gastric wedge resection is feasible for treating gastric GISTs in selected patients.

Keyword

Gastrointestinal stromal tumors; Stomach; Prognosis; Laparoscopy

MeSH Terms

Daegu
Female
Gastrointestinal Stromal Tumors*
Hospitals, University
Humans
Korea
Laparoscopy
Male
Medical Records
Prognosis
Recurrence
Retrospective Studies*
Rupture
Stomach*

Figure

• 

  Fig. 1 Yearly changes in the proportion of open resection and laparoscopic resection for gastric gastrointestinal stromal tumors (GISTs). There showed an increasing tendency to perform laparoscopic resections for gastric GISTs.

Reference

1. Blay JY, Bonvalot S, Casali P, Choi H, Debiec-Richter M, Dei Tos AP, et al. Consensus meeting for the management of gastrointestinal stromal tumors. Report of the GIST Consensus Conference of 20-21 March 2004, under the auspices of ESMO. Ann Oncol. 2005; 16:566–578.

2. Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, et al. Diagnosis of gastrointestinal stromal tumors: A consensus approach. Hum Pathol. 2002; 33:459–465.

3. Heinrich MC, Corless CL, Demetri GD, Blanke CD, von Mehren M, Joensuu H, et al. Kinase mutations and imatinib response in patients with metastatic gastrointestinal stromal tumor. J Clin Oncol. 2003; 21:4342–4349.

4. Miettinen M, Sobin LH, Lasota J. Gastrointestinal stromal tumors of the stomach: a clinicopathologic, immunohistochemical, and molecular genetic study of 1765 cases with long-term follow-up. Am J Surg Pathol. 2005; 29:52–68.

5. Miettinen M, Lasota J. Gastrointestinal stromal tumors: review on morphology, molecular pathology, prognosis, and differential diagnosis. Arch Pathol Lab Med. 2006; 130:1466–1478.

6. Nilsson B, Bumming P, Meis-Kindblom JM, Oden A, Dortok A, Gustavsson B, et al. Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era: a population-based study in western Sweden. Cancer. 2005; 103:821–829.

7. Tran T, Davila JA, El-Serag HB. The epidemiology of malignant gastrointestinal stromal tumors: an analysis of 1,458 cases from 1992 to 2000. Am J Gastroenterol. 2005; 100:162–168.

8. Pierie JP, Choudry U, Muzikansky A, Yeap BY, Souba WW, Ott MJ. The effect of surgery and grade on outcome of gastrointestinal stromal tumors. Arch Surg. 2001; 136:383–389.

9. DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg. 2000; 231:51–58.

10. Hassan I, You YN, Shyyan R, Dozois EJ, Smyrk TC, Okuno SH, et al. Surgically managed gastrointestinal stromal tumors: a comparative and prognostic analysis. Ann Surg Oncol. 2008; 15:52–59.

11. Cho MY, Sohn JH, Kim JM, Kim KM, Park YS, Kim WH, et al. Current trends in the epidemiological and pathological characteristics of gastrointestinal stromal tumors in Korea, 2003-2004. J Korean Med Sci. 2010; 25:853–862.

12. Kim KH, Kim MC, Jung GJ, Kim SJ, Jang JS, Kwon HC. Long term survival results for gastric GIST: is laparoscopic surgery for large gastric GIST feasible? World J Surg Oncol. 2012; 10:230.

13. Matthews BD, Joels CS, Kercher KW, Heniford BT. Gastrointestinal stromal tumors of the stomach. Minerva Chir. 2004; 59:219–231.

14. Das A, Wilson R, Biankin AV, Merrett ND. Surgical therapy for gastrointestinal stromal tumours of the upper gastrointestinal tract. J Gastrointest Surg. 2009; 13:1220–1225.

15. Washington K. 7th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol. 2010; 17:3077–3079.

16. Kim KM, Kang DW, Moon WS, Park JB, Park CK, Sohn JH, et al. Gastrointestinal stromal tumors in Koreans: it\'s incidence and the clinical, pathologic and immunohistochemical findings. J Korean Med Sci. 2005; 20:977–984.

17. Rutkowski P, Wozniak A, Debiec-Rychter M, Kakol M, Dziewirski W, Zdzienicki M, et al. Clinical utility of the new American Joint Committee on Cancer staging system for gastrointestinal stromal tumors: current overall survival after primary tumor resection. Cancer. 2011; 117:4916–4924.

18. Fujimoto Y, Nakanishi Y, Yoshimura K, Shimoda T. Clinicopathologic study of primary malignant gastrointestinal stromal tumor of the stomach, with special reference to prognostic factors: analysis of results in 140 surgically resected patients. Gastric Cancer. 2003; 6:39–48.

19. Privette A, McCahill L, Borrazzo E, Single RM, Zubarik R. Laparoscopic approaches to resection of suspected gastric gastrointestinal stromal tumors based on tumor location. Surg Endosc. 2008; 22:487–494.

20. Matthews BD, Walsh RM, Kercher KW, Sing RF, Pratt BL, Answini GA, et al. Laparoscopic vs open resection of gastric stromal tumors. Surg Endosc. 2002; 16:803–807.

21. Rosen MJ, Heniford BT. Endoluminal gastric surgery: the modern era of minimally invasive surgery. Surg Clin North Am. 2005; 85:989–1007.

22. Nishida T, Hirota S, Yanagisawa A, Sugino Y, Minami M, Yamamura Y, et al. Clinical practice guidelines for gastrointestinal stromal tumor (GIST) in Japan: English version. Int J Clin Oncol. 2008; 13:416–430.

23. Demetri GD, von Mehren M, Blanke CD, Van den Abbeele AD, Eisenberg B, Roberts PJ, et al. Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med. 2002; 347:472–480.

24. Iesalnieks I, Rummele P, Dietmaier W, Jantsch T, Zulke C, Schlitt HJ, et al. Factors associated with disease progression in patients with gastrointestinal stromal tumors in the pre-imatinib era. Am J Clin Pathol. 2005; 124:740–748.

25. van der Zwan SM, DeMatteo RP. Gastrointestinal stromal tumor: 5 years later. Cancer. 2005; 104:1781–1788.

26. Bucher P, Egger JF, Gervaz P, Ris F, Weintraub D, Villiger P, et al. An audit of surgical management of gastrointestinal stromal tumours (GIST). Eur J Surg Oncol. 2006; 32:310–314.

27. Yang HK, Park do J, Lee HJ, Kim HH, Kim WH, Lee KU. Clinicopathologic characteristics of gastrointestinal stromal tumor of the stomach. Hepatogastroenterology. 2008; 55:1925–1930.

28. Honda M, Hiki N, Nunobe S, Ohashi M, Kiyokawa T, Sano T, et al. Long-term and surgical outcomes of laparoscopic surgery for gastric gastrointestinal stromal tumors. Surg Endosc. 2014; 28:2317–2322.