Gastrointestinal Stromal and Other Mesenchymal Gastric Tumors – Laparoscopic Management?

Česká verzia

Authors: L. Sákra; J. Šiller; P. Vyhnálek ^*; M. Hácová ^**
Authors place of work: Fakulta zdravotnických studií Univerzity Pardubice Chirurgická klinika Krajské nemocnice Pardubice a. s., přednosta: doc. MUDr. J. Šiller, Ph. D. ; Interní klinika, přednosta MUDr. P. Vyhnálek, Ph. D. ^*; Patologicko-anatomické oddělení a oddělení soudního lékařství, přednosta: MUDr. P. Rothrockel ^**
Published in the journal: Rozhl. Chir., 2010, roč. 89, č. 6, s. 352-355.
Category: Monothematic special - Original

Summary

Introduction:
This study was aimed to evaluate a set of gastrointestinal stromal tumors (GIST) of the stomach managed with a laparoscopic technique (GIST).

Materials and methods:
The study covers a period from January 1, 2007 until December 31, 2009 during which 12 patients underwent the laparoscopic removal of stomach tumors in the Regional Hospital in Pardubice. In all cases tumors were removed completely in a laparoscopic way, including the healthy border of the stomach tissue. The defect created in the stomach wall was sutured laparoscopically as well. On completion the sufficiency of the sutures was reviewed gastroscopically.

Results:
No death was observed in our study. Two patients suffered from wound infection (secondary healing), one of them requiring repeat surgery owing to the excessive narrowing of the distal part of the stomach. The dehiscence of the laparoscopic suture or other intraabdominal complications was not observed. 3 patients underwent chemotherapy by Imitinib. During surveillance all patients were free of signs of tumor progression or local recurrence.

Discussion:
Gastric GISTs are very rare tumors but their incidence is increasing. At this time the consensus about the necessity of preoperative unambiguous differentiation between malignant or less malignant variants is not available. The strict differentiation is very difficult and the determination to choose a more radical surgical approach for more malignant variants is not clear-cut.

Conclusion:
In case of gastric GIST the local removal of a tumor with the healthy border of the stomach tissue may be chosen as an adequate approach. Our results support this local surgical approach.

Key words:
GIST – stomach laparoscopy

Zdroje

1. Mazur, M. T., Clark, H. B. Gastric stroma tumors: Reappraisal of histogenesi. Am. J. Surg. Pathos., 1983, č. 7, s. 507–519.

2. Sarlomo-Rikala, M., Kovatich, A., Barusevicius, A., et al. CD 117: A sensitive marker for gastrointestinal stroma tumors that is more specific than CD 34. Mod. Pathol., 1998, č. 11, s. 728–734.

3. Miettinen, M., Sarlomo-Rikala, M., Lasota, J. Recent advances in understanding of thein biology. Human Patology, 1999, roč. 30, č. 10, s. 1213–1218.

4. Mucciarini, C., Rossi, G., Bertolini, F., et al. Incidence and clinicopathologic features of gastrointestinal stroma tumors. A population-based study. BMC Cancer, 2007, roč. 7, č. 230, s. 1186.

5. Nilsson, B., Bumming, P., Meis-Kindblom, J. M., 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, č. 103, s. 821–829.

6. Wu, T., Lee, L., Yeh, Ch., Wu, P., Chao, T., et al. Surgical treatment and prognostic analysis for gastrointestinal stroma tumor sof the small intestine: efore era of imatinib mesylate. BMC Gastroenterol., 2006, roč. 6, č. 29, s. 323–341.

7. Wente, M., Buchler, M., Weitz, J. Gastrointestinal stromal tumors (GIST). Surgical therapy. Chirurg, 2008, roč. 79, č. 7, s. 638–643.

8. Warsi, A., Peyser, P. Laparoscopic resection of gastric GIST and benign gastric tumors: evolution of a new technique. Surg. Endosc., 2009, č. 9, s. 561–569.

9. Basso, N., Rosato, P., De Leo, A., Picconi, T., Trentino, P., Fantini, A., et al. Laparoscopic treatment of gastric stromal tumors. Surg. Endosc., 2000, roč. 14, č. 6, s. 524–526.

10. Everest, M., Gutman, H. Gastrointestinal stromal tumors. Surg. Oncol., 2008, r. 15, č. 8, s. 588–593.

11. Miettinen, M., Lasota, J. Gastrointestinal stroma tumors: review on morphology, molecular pathology, prognosis, and differential diagnosis. Arch. Pathol. Lab. Med., 2006, č. 130, s. 1466–1478.

12. Rabin, I., Chilkman, B., Lavy, R., Sandbank, J., Maklakovsky, M., Gold-deutch, R., Halpren, Z., Wassermann, I., Halevy, A. Gastrointestinal stromal tumors: A 19 year experience. IMAJ, 2009. č. 12, s. 98–102.

13. Rutkowski, P., Nowecki, Z. I., Michej, W., et al. Risk criteria and prognostic factors for predicting recurrences after resection of primary gastrointestinal stromal tumors. Ann. Surg. Oncol., 2007, č. 14, s. 2018–2027.

14. Rubió, J., Narcis-Gragera, R., Ortiz, M. R., et al. Population based incidence and survival of gastrointestinal stroma tumors (GIST) in Gerona, Spain. Eur. J. Cancer, 2007, č. 43, s. 144–148.

15. Brabec, P., Sufliarsky, J., Linke, Z., et al. A whole population study of gastrointestinal stroma tumors in the Czech Republic and Slovakia. Neoplasma, 2009, roč. 56, č. 5, s. 459–463.

16. Buchler, P., Morel, P. Rev Med Suisse. 2008, roč. 25, č. 4, s. 1567–1570.

17. Miettinen, M., Lasota, J. Gastrointestinal stromal tumors – definition, clinical, histological, imunohistochemical and molecular genetic features and differential diagnosis. Virchov. Arch., 2001, č. 438, s. 1–12.