Transsacrococcygeal approach in rectal gastrointestinal stromal tumour resection: 10-year experience at a single centre

Abstract

Background: The transsacrococcygeal (TSC) approach in rectal gastrointestinal stromal tumour (GIST) resection is clinically challenging and controversial, and we evaluated its value in the present study. Methods:We enrolled patients who underwent rectal GIST resection by the TSC approach during 2008-2018. The clinicopathological index, surgical outcome, and prognosis were analysed. Prognostic information was obtained from medical records and follow-up data. Anal function was evaluated by the low anterior resection syndrome (LARS) score.Results: Among 88 rectal GIST patients over the 10-year study period, 17 who underwent the TSC approach were analysed. The median age was 55 (range, 26-73) years. In total, 15 patients received preoperative imatinib neoadjuvant therapy for 232 (30-690) days. The tumours were exogenous in 14 patients and intramural in 3 patients. The mean initial tumour size and preoperative tumour size were 6.4±2.2 and 4.2±1.7 cm, respectively. The operative time and blood loss were 130.2±47.4 min and 44.6±36.0 mL, respectively. Of the 17 patients 7 had postoperative complications (within 30 days postoperatively), and the complications of 5 patients were cured by conservative treatment. Only 1 patient was lost to follow-up, and the others had a good oncological prognosis at recent follow-up evaluations. All patients had LARS scores ≤9 points at 1 year after the operation. Conclusions:The TSC approach can result in a good oncological prognosis, usually does not affect anal function, and is particularly suitable for exogenous middle and low rectal GISTs. However, it might cause some controlled complications. Hence, careful patient selection is necessary for this operation.

A systematic review and meta‐analysis of neoadjuvant imatinib use in locally advanced and metastatic gastrointestinal stromal tumors

“…Thrity five studies were ultimately included for final analysis 6 ,. 12 , 13–46 An additional study meeting the inclusion criteria was identified from citation searching, 47 bringing the total number of final included articles to 36. The PRISMA flow diagram (Figure 1) outlines the study selection process and details the rationale for study exclusion.…”

Leiomyosarcoma of the rectum: A systematic review of recent literature

“…Various surgical techniques and approaches for local resection of rGISTs have been widely described, including open transanal resection, 92 transanal endoscopic microsurgery (TEM), 93–95 transanal minimally invasive surgery (TAMIS), 96,97 laparoscopic 98,99 transperineal 100,101 presacral 102,103 transacral 104–106 and transvaginal approaches 107–109 …”

“…Various surgical techniques and approaches for local resection of rGISTs have been widely described, including open transanal resection, 92 transanal endoscopic microsurgery (TEM), [93][94][95] transanal minimally invasive surgery (TAMIS), 96,97 laparoscopic 98,99 transperineal 100,101 presacral 102,103 transacral [104][105][106] and transvaginal approaches. [107][108][109] Imatinib therapy appears to be the standard first-line treatment for locally advanced, inoperable, and metastatic patients, and for metastatic patients who have had all lesions surgically removed.…”

Recent Advancements in the Treatment of Rectal Gastrointestinal Stromal Tumor: In Era of Imatinib

“…Although all patients have a good oncological prognosis, 7 of the 17 patients experienced postoperative complications. 21 Anastomotic leakage was found in 5 cases and poor wound healing in 2 cases. Two patients with anastomotic leakage recovered after conservative treatment, including without forced drainage and lavage, and one patient underwent sigmoidostomy.…”