Incidental gastric mesenchymal tumors identified during laparoscopic sleeve gastrectomy11Support provided by Puget Sound Surgical Center.

Crouthamel, Matthew; Kaufman, Jedediah; Billing, Josiah; Billing, Peter; Landerholm, Robert

doi:10.1016/j.soard.2015.06.004

Cited by 29 publications

(17 citation statements)

References 13 publications

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“…There are several research studies about findings during bariatric surgery. Most GISTs found were at very low risk stratification following modified NIH criteria: Chiappetta et al [ 21 ] found 0.31% (8/2603) GISTs during RYGB and SG, Yuval et al [ 22 ] reported 0.6% (5/827) GISTs during SG, Sanchez et al [ 23 ] found 0.8% (4/517) GISTs during RYGB, and Crouthamel et al [ 24 ] found 0.8% GISTs (12/1415) during SG, out of which only one was larger than 20 mm.…”

Section: Discussionmentioning

confidence: 99%

Bariatric surgery and incidental gastrointestinal stromal tumors - a single-center study: VSJ Competition, 1 place.

Różańska-Walędziak¹,

Kowalewski²,

Janik³

et al. 2017

Videosurgery and Other Miniinvasive Techniques

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IntroductionGastrointestinal stromal tumors (GISTs), originating from Cajal cells, are most commonly located in the stomach; therefore they can be found in the specimens excised during bariatric operations. The global prevalence of GISTs is about 130 cases per million population. Morbidity differs depending on geographical latitude. Although surgery is the treatment of choice for GISTs, 40–50% of patients after radical surgical treatment will have a relapse or metastases.AimTo analyze the incidence of GISTs in patients undergoing bariatric surgery and to verify whether an operation performed according to the bariatric protocol is oncologically radical in case of GIST.Material and methodsA single-center retrospective study. The study group comprised 1252 obese patients qualified for bariatric procedures, with no upper gastrointestinal tract neoplasms found during preoperative diagnostic examinations. In case of suspicious macroscopic pathologies (n = 81) present during the operation, tissue specimens underwent histopathological examination with further investigation performed if GISTs were found, including tumor size and localization, mitotic index and immunohistochemical analysis.ResultsGastrointestinal stromal tumors were found in 16 cases, and benign tumors of various histological origin in 33 cases. All cases of GIST found came from stomach specimens, 7 from the gastric corpus vs. 9 from the fundus. Fourteen GISTs were found during laparoscopic sleeve gastrectomies (LSGs) vs. 2 during laparoscopic Roux-en-Y gastric bypasses (LRYGBs).ConclusionsIn case of incidental findings of GISTs during bariatric surgery, tumor resection with negative margins of incision may be considered as complete oncological treatment if there was very low/low risk stratification of GIST’s recurrence after surgery.

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Section: Discussionmentioning

confidence: 99%

Bariatric surgery and incidental gastrointestinal stromal tumors - a single-center study: VSJ Competition, 1 place.

Różańska-Walędziak¹,

Kowalewski²,

Janik³

et al. 2017

Videosurgery and Other Miniinvasive Techniques

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“…Incidental GIST finding in bariatric surgery is rare with a reported incidence between 0.3%-1.2% in different series of sleeve gastrectomy and gastric bypass[ 59 - 61 ]. In many cases, the performed procedure may be curative; however, the finding of GISTs in certain locations such as the gastroesophogeal junction or lesser curve could require abandoning the proposed technique in favor of a suitable and complete tumor excision[ 59 ].…”

Section: Resactable Diseasementioning

confidence: 99%

Gastrointestinal stromal tumors: A multidisciplinary challenge

Sánchez-Hidalgo¹,

Durán²,

Molero-Payan³

et al. 2018

WJG

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Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors located in the alimentary tract. Its usual manifestation is gastrointestinal bleeding. However, small asymptomatic lesions are frequently detected as incidental finding. Characteristically, most GISTs (> 95%) are positive for the KIT protein (CD117) by IHC staining and approximately 80%-90% of GISTs carry a mutation in the c-KIT or PDGFRA genes. Mutational analysis should be performed when planning adjuvant and neoadjuvant therapy, due to its possible resistance to conventional treatment. The arise of tyrosine kinase inhibitor has supposed a revolution in GISTs treatment being useful as adjuvant, neoadjuvant or recurrence disease treatment. That is why a multidisciplinary approach to this disease is required. The correct characterization of the tumor at diagnosis (the diagnosis of recurrences and the evaluation of the response to treatment with tyrosine kinase inhibitors) is fundamental for facing these tumors and requires specialized Endoscopist, Radiologists and Nuclear Medicine Physician. Surgery is the only potentially curative treatment for suspected resectable GIST. In the case of high risk GISTs, surgery plus adjuvant Imatinib-Mesylate for 3 years is the standard treatment. Neoadjuvant imatinib-mesylate should be considered to shrink the tumor in case of locally advanced primary or recurrence disease, unresectable or potentially resectable metastasic tumors, and potentially resectable disease in complex anatomic locations to decrease the related morbidity. In the case of Metastatic GIST under Neoadjuvant treatment, when there are complete response, stable disease or limited disease progression, complete cytoreductive surgery could be a therapeutic option if feasible.

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“…En el estómago, se presentan más frecuentemente en el fondo y en el cardias; sin embargo, en esta serie dos se presentaron en la curvatura mayor y uno en el cuerpo gástrico 5 . Su incidencia varía de 6,5 a 14,5 casos por millón de habitantes 6 . Se encuentran asociados a enfermedades hereditarias, como la neurofibromatosis de tipo I o la tríada de Carney, aunque en los presentes casos ninguno tenía antecedentes de este tipo de enfermedades genéticas 7 .…”

Section: Discussionunclassified

“…El tratamiento estándar es la resección oncológica sin linfadenectomía, ya que la diseminación ganglionar es nula. Sin embargo, no se excluye la posibilidad de que produzcan metástasis peritoneales o hepáticas, que no son infrecuentes, sobre todo en centros con gran casuística 6 . En este estudio se presenta una serie de 3 casos de tumor del estroma gastrointestinal como hallazgo incidental en la cirugía bariátrica, de un grupo de 320 pacientes intervenidos por obesidad, se hace una revisión de la literatura cientí-fica y se propone un algoritmo de manejo…”

Section: Introductionunclassified

Manejo de tumores gástricos del estroma gastrointestinal encontrados en cirugía bariátrica: un desafío quirúrgico

et al. 2018

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ResumenIntroducción. Se han reportado hallazgos incidentales durante la cirugía bariátrica, como tumores gástricos (0,6 a 0,8 %), entre los cuales el más frecuente es el del estroma gastrointestinal (GIST). Es importante tener en cuenta que el pilar del tratamiento de este tipo de tumores es la cirugía con márgenes negativos. Métodos y resultados. Se llevó a cabo un estudio retrospectivo, descriptivo y observacional, desde enero de 2013 hasta junio de 2016; durante este periodo, 320 pacientes fueron sometidos a cirugía bariátrica, manga gástrica en 250 y derivación gástrica en 70, en la Clínica Universitaria El Bosque. En tres de ellos, dos con manga gástrica y uno con derivación gástrica, se encontró incidentalmente un tumor gástrico del estroma gastrointestinal (GIST) con confirmación por histopatología; mediante escisión, se obtuvieron bordes negativos para tumor, no se presentaron complicaciones ni se prolongó la estancia hospitalaria. Discusión y conclusiones. Teniendo en cuenta la ubicación de la lesión, es posible la intervención laparoscópica de los tumores gástricos del estroma gastrointestinal de 2 cm o más, encontrados durante un procedimiento de cirugía bariátrica. Palabras clave: tumores del estroma gastrointestinal; estómago; obesidad; cirugía bariátrica; derivación gástrica; laparoscopía. AbstractIntroduction: Incidental findings are reported in bariatric surgery, such as gastric tumors in 2% to 8%, gastrointestinal stromal tumors (GIST) being the most frequent. The pillar of handling this type of tumor is surgery with negative margins. Methods and Results: This is a descriptive retrospective study covering the period January 2013 to June 2016 during which 320 patients underwent bariatric surgery, 250 gastric sleeve and 70 gastric bypass, among which three had the incidental finding of gastric GIST confirmed by pathology; two patients had gastric sleeve and one gastric bypass; resection of the tumor was carried out obtaining adequate negative margins with no morbidities and no prolonged hospital stay. Discussion and Conclusions: Gastric sleeve and gastric bypass are the preferred surgical options in bariatric surgery, allowing resection of the incidentally found gastrointestinal stromal tumors for curative treatment, without altering the outcome or purpose of the bariatric surgery procedure.

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Incidental gastric mesenchymal tumors identified during laparoscopic sleeve gastrectomy11Support provided by Puget Sound Surgical Center.

Cited by 29 publications

References 13 publications

Bariatric surgery and incidental gastrointestinal stromal tumors - a single-center study: VSJ Competition, 1 place.

Bariatric surgery and incidental gastrointestinal stromal tumors - a single-center study: VSJ Competition, 1 place.

Gastrointestinal stromal tumors: A multidisciplinary challenge

Manejo de tumores gástricos del estroma gastrointestinal encontrados en cirugía bariátrica: un desafío quirúrgico

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