Initial application of transanal endoscopic microsurgery for high-risk lower rectal gastrointestinal stromal tumor after imatinib mesylate neoadjuvant chemotherapy

Abstract

Rationale:The lower rectal gastrointestinal stromal tumor (GIST) is a rare entity and warrants special attentions because of the considerations of preserving of anal and urinal functions. Neoadjuvant therapy with imatinib mesylate (IM) has achieved great success in GIST, which potentially extends the applications of function-preserving minimally invasive surgical procedures. Transanal endoscopic microsurgery (TEM) is a well-developed minimally invasive technique for benign tumors in lower rectum. Herein, we reported the initial application of TEM for high risk GIST after IM treatment.Patient concerns:A 52-year-old woman suffered mild lower abdominal pain and perianal discomfort. Physical examination found a soft mass 4 cm far away from anal verge. Rectal MRI and transrectal ultrasound (TRUS) showed that there was a 1.9 × 1.6 cm submucosal mass in the lower rectum. The incisional biopsy was performed and the pathological result reported it was a high-risk GIST.Diagnoses:High-risk lower rectal GIST.Interventions:IM was given for neoadjuvant therapy. Then TEM was adopted to resect the residual tumor. IM was restored 4 weeks after surgery.Outcomes:The final pathological results reported the margin was clear. After an 18-month follow up, no recurrence and metastasis was found and the patient had a satisfactory anal and urinal functions.Lessons:TEM in combination with IM could be a practical strategy for the high-risk lower rectal GIST simultaneously to achieve curative resection and to preserve the anal and urinal functions that can significantly improve the life quality of the patients.

Transvaginal Resection of a Rectal Gastrointestinal Stromal Tumor: A Case Report

“…There are several surgical techniques described, from conventional transanal resection (Parks), trans-sacral approach (Kraske), transanal endoscopic microsurgery (TEM), transanal minimally invasive surgery (TAMIS), laparoscopic and laparotomic surgery (anterior resection of the rectum, abdominalperineal amputation) [13][14][15][16][17]. The method of choice is decided according to the characteristics of the tumor (size, extent, location) and according to the surgeon's preferences.…”

Open transanal resection of low rectal stromal tumor following neoadjuvant therapy of imatinib mesylate: Report of 11 cases and review of literature

“…GIST originates from the gastrointestinal tract, with a low incidence in the rectum . Because of its high degree of malignancy, early detection and early treatment are important to improve the prognosis .…”

A Population-Based Study of the Incidence and Survival of Anorectal Gastrointestinal Stromal Tumor

“…In recent decades, imatinib has been shown to be an effective preoperative chemotherapy agent in reducing tumor size and mitotic activity, making radical surgical resection more feasible and increasing the chance of preservation of the anal sphincter [23,25]. Recently, several studies have reported the superiority and advantage of the use of surgery with the combined use of adjuvant imatinib for anorectal GIST [26][27][28]. However, because of the limited number of only five patients with anorectal GIST included in the study by Kaneko et al [25], it is difficult to directly compare the findings from the present study.…”