Chirurgia (Bucur). 2010 Jul-Aug;105(4):577-85. Surgical Oncology (2008) 17, 129–138
Although their overall incidence is low, GISTs are distinctive subgroup of gastrointestinal mesenchymal tumors which express CD117 or platelet derived growth factor receptor alpha (PDGFRA). Considered as rare digestive cancers, tumors like schwannomas, neurofibromas, gastrointestinal leiomiomas are now reclassified as GIST based on immunohistochemistry studies.
GIST are more frequent in stomach (40-70%), small bowel (20-40%), colon (5-15%), meanwhile locations such as mesentery, omentum, retro peritoneum in less of 5%. 10 GIST patients were surgically managed during 2004-2009. 5 gastric and 5 small bowel GIST. Most with symptomatic disease: palpable tumor, abdominal pain, anemia, fatigue, superior digestive hemorrhage or occlusion. Imagistic diagnosis consisted of: barium swallow, abdominal sonography, CT and PET-CT.
Confirmation was made by hystopathological exam and immunohistochemistry. All patients had more or less wide surgical resections. For some patients there was also a specific adjuvant treatment. All patients survived after surgery.
The principle of surgery for GIST is RO resection of the tumor. Tumor rupture or R1 resection of the primary tumor has a negative impact on disease free survival. Some patients (great volume tumors, R1 or R2 resection) had adjuvant treatment. Imatinib mesylate and derivates showed a significant improvement of recurrence free survival with one condition: permanent treatment. Surgery remains the mainstay of treatment in patients with localized, resectable GIST. Recurrence rate of 17-21% and 5 years survival rate of 48-70%, even in resectable GIST, impose an adjuvant treatment
A long-term follow-up is essential for all patients with GIST independent of a benign or malignant designation, since these tumors have an uncertain biological behavior. Although active post-operative surveillance program is important there is no consensus on a standard protocol for the follow-up of these patients. As most of the recurrences occur within the first 3–5 years, intense surveillance is required during this period
FOLLOW UP:
According to the National Comprehensive Cancer Network guidelines, contrast CT of
the abdomen and pelvis is recommended every 3–6 months for 3–5 years and then yearly [105]. The European Society of Medical Oncology guidelines stratify the surveillance based on the tumor size and mitoses [106]. Tumor size 45 cm and mitoses 45/HPF require contrast CT for every 3–4 months for 3 years followed by every 6 months for the next 2 years, and later yearly. Smaller size tumors (o5 cm) and lowmitotic count (o5/HPF) requires contrast CTevery 6 months for 5 years [106]. According to Novitsky et al. [6] most of the recurrence occurs during the first 2 years after surgical resection. They follow-up the patient with physical examination
every 3–4 months for 2 years, then every 6 months for the next 2 years, then yearly. Chest X-ray and abdominal CT scan and blood test were obtained yearly. Flexible upper endoscopy is performed at 6 months and 1-year postoperatively
and then annually for 2 years. PET scanning of abdomen, MR imaging, or chest CT scan is done if abnormalities are found in any of the surveillance studies.
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Gastro Surgeon
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Dr. Keyur Bhatt - Best
Gastro Surgeon
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Surgeon - Dr Keyur Bhatt - Best Gastro Surgeon
Dr. Keyur Bhatt- Best GI
Surgeon - Dr Keyur Bhatt - Best Gastro Surgeon
Dr Keyur
Bhatt- Best GI Surgeon
