Endoscopic versus surgical resection of GI stromal tumors in the upper GI tract

Joo, Moon Kyung; Park, Jong Jae; Kim, Ho; Koh, Jin Sung; Lee, Beom Jae; Chun, Hoon Jai; Lee, Sang Woo; Jang, Young-Joo; Mok, Young Jae; Bak, Young Tae

doi:10.1016/j.gie.2015.07.034

Cited by 83 publications

(69 citation statements)

References 35 publications

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“…Most cases are sporadic, whereas familial clustering is reported in only 1.5-4% of the cases (69,102). Familial GIST is an autosomal dominant condition caused by germline mutations of cKIT or PDGFRA and manifests at earlier age.…”

Section: Risk Factorsmentioning

confidence: 99%

“…Exon 11 mutations carry a better prognosis and respond well to standard dose (400 mg/dayly) of imatinib (116). Some authors reported worse outcomes in exon 9 mutation (102). Approximately 8% of the cases have PDGRFA mutation, which is mutually exclusive with cKIT but is associated with longer relapse-free interval (43,59,116).…”

Section: Histopathology and Molecular Characteristicsmentioning

confidence: 99%

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Surgical treatment of gastrointestinal stromal tumors of the duodenum: a literature review

Popivanov¹,

Tabakov²,

Mantese³

et al. 2018

Transl. Gastroenterol. Hepatol

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Background: Gastrointestinal stromal tumors (GIST) are the most frequent mesenchymal tumours in the digestive tract. The duodenal GIST (dGIST) is the rarest subtype, representing only 4-5% of all GIST, but up to 21% of the resected ones. The diagnostic and therapeutic management of dGIST may be difficult due to the rarity of this tumor, its anatomical location, and the clinical behavior that often mimic a variety of conditions; moreover, there is lack of consent for their treatment. This study has evaluated the scientific literature to provide consensus on the diagnosis of dGIST and to outline possible options for surgical treatment.Methods: An extensive research has been carried out on the electronic databases MEDLINE, Scopus, EMBASE and Cochrane to identify all clinical trials that report an event or case series of dGIST.Results: Eighty-six studies that met the inclusion criteria were identified with five hundred forty-nine patients with dGIST: twenty-seven patients were treated with pancreatoduodenectomy and ninety-six with only local resection (segmental/wedge resections); in four hundred twenty-six patients it is not possible identify the type of treatment performed (pancreatoduodenectomy or segmental/wedge resections).Conclusions: dGISTs are a very rare subset of GISTs. They may be asymptomatic or may involve symptoms of upper GI bleeding and abdominal pain at presentation. Because of the misleading clinical presentation the differential diagnosis may be difficult. Tumours smaller than 2 cm have a low biological aggressiveness and can be followed annually by endoscopic ultrasound. The biggest ones should undergo radical surgical resection (R0). In dGIST there is no uniformly adopted surgical strategy because of the low incidence, lack of experience, and the complex anatomy of the duodenum. Therefore, individually tailored surgical approach is recommended. R0 resection with 1-2 cm clear margin is required. Lymph node dissection is not recommended due to the low incidence of lymphatic metastases. Tumor rupture should be avoided.

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Section: Risk Factorsmentioning

confidence: 99%

Section: Histopathology and Molecular Characteristicsmentioning

confidence: 99%

Surgical treatment of gastrointestinal stromal tumors of the duodenum: a literature review

Popivanov¹,

Tabakov²,

Mantese³

et al. 2018

Transl. Gastroenterol. Hepatol

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“…Moreover, only patients with small low-risk well-defined tumors should be considered eligible for endoscopic GIST removal in one part. R1 resection is more frequent in the endoscopic resection but the recurrence rate in some studies is as low as 3% and is therefore not much different from surgical resection [13,23]. Joo et al [23] reported an R0 resection rate of 25.6% in the endoscopy group, whereas it was 85.0% in the surgery group (p < 0.001).…”

Section: Laparoscopy/endoscopy In the Treatment Of Gistmentioning

confidence: 99%

“…R1 resection is more frequent in the endoscopic resection but the recurrence rate in some studies is as low as 3% and is therefore not much different from surgical resection [13,23]. Joo et al [23] reported an R0 resection rate of 25.6% in the endoscopy group, whereas it was 85.0% in the surgery group (p < 0.001). In the endoscopy group, 50.0% of resected tumors belonged to a very low-risk group, whereas 35.0 and 30.0% belonged to the low-risk and high-risk surgery group (p < 0.001), respectively.…”

Section: Laparoscopy/endoscopy In the Treatment Of Gistmentioning

confidence: 99%

Is the Surgical Margin in Gastrointestinal Stromal Tumors Different

2018

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Background: Radical surgical excision is the mainstay of therapy of primary, nonmetastatic gastrointestinal stromal tumors (GIST) and margin status after surgery is a significant prognostic factor. Methods and Results: The aim of this paper is to review principles in primary GIST surgery, i.e. differences between R0, R1, and R2 resection, to describe how surgical margin status and tumor intraperitoneal rupture influence the patients' outcome, and how this may be effected by neoadjuvant and adjuvant treatment in locally advanced tumors. A systematic search of literature published between 2000 and 2018 was performed regarding this topic. Conclusion: Correct interpretation of margin status after surgery can be affected by many factors during operation and preparation of tissue.

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“…They made no mention of the histological status of the endoscopically excised tumors although they reported no macroscopic tumor residue. Joo et al (6) reported conducting endoscopic resection in 90 GIST patients, 23 (25.6%) of whom microscopic complete resection with histologically negative margins was achieved. Although only one patient showed recurrence after the median follow-up of 31.5 months in Shen et al's study, delayed local recurrence is not rare in GIST (7).…”

Section: Editorialmentioning

confidence: 99%

Is a “wait-and-see” policy the best for small gastric gastrointestinal stromal tumor (GIST)?

Kanda¹

2016

Transl. Gastroenterol. Hepatol.

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Endoscopic versus surgical resection of GI stromal tumors in the upper GI tract

Cited by 83 publications

References 35 publications

Surgical treatment of gastrointestinal stromal tumors of the duodenum: a literature review

Surgical treatment of gastrointestinal stromal tumors of the duodenum: a literature review

Is the Surgical Margin in Gastrointestinal Stromal Tumors Different

Is a “wait-and-see” policy the best for small gastric gastrointestinal stromal tumor (GIST)?

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