Gastrointestinal stromal tumor surgery: Difference between revisions

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{{CMG}}{{AE}}{{PSD}}
 
{{CMG}};{{AE}}{{Akshun}}{{PSD}}
{{Gastrointestinal stromal tumor}}
{{Gastrointestinal stromal tumor}}
==Overview==
The mainstay of treatment for gastrointestinal stromal tumor (GIST) is surgical [[resection]]. Surgical [[resection]] offers an opportunity to completely cure GIST. [[Laparoscopic]] and [[endoscopic]] [[resection]] are the most preferred route of [[surgery]]. Surgical [[resection]] of GIST include complete gross [[resection]] with an intact pseudocapsule and negative [[microscopic]] margins.
==Surgical Therapy==


Surgical Therapy
[[Surgery]] is the definitive [[therapy]] and typically the initial [[therapy]] for [[Patient|patients]] of  gastrointestinal stromal tumor (GIST).
 
*Surgical resection offers an opportunity to completely cure GIST.
Surgery is typically the initial therapy for the following types of patients:
*[[Laparoscopic]] and [[endoscopic]] resection are the most preferred route of surgery. The indications for surgery include:<ref name="pmid23917593">{{cite journal |vauthors=Liang JW, Zheng ZC, Zhang JJ, Zhang T, Zhao Y, Yang W, Liu YQ |title=Laparoscopic versus open gastric resections for gastric gastrointestinal stromal tumors: a meta-analysis |journal=Surg Laparosc Endosc Percutan Tech |volume=23 |issue=4 |pages=378–87 |year=2013 |pmid=23917593 |doi=10.1097/SLE.0b013e31828e3e9d |url=}}</ref><ref name="pmid23898104">{{cite journal |vauthors=DE Vogelaere K, VAN DE Winkel N, Simoens C, Delvaux G |title=Intragastric SILS for GIST, a new challenge in oncologic surgery: first experiences |journal=Anticancer Res. |volume=33 |issue=8 |pages=3359–63 |year=2013 |pmid=23898104 |doi= |url=}}</ref><ref name="pmid23233005">{{cite journal |vauthors=De Vogelaere K, Hoorens A, Haentjens P, Delvaux G |title=Laparoscopic versus open resection of gastrointestinal stromal tumors of the stomach |journal=Surg Endosc |volume=27 |issue=5 |pages=1546–54 |year=2013 |pmid=23233005 |doi=10.1007/s00464-012-2622-8 |url=}}</ref><ref name="pmid28486486">{{cite journal |vauthors=Ye L, Wu X, Wu T, Wu Q, Liu Z, Liu C, Li S, Chen T |title=Meta-analysis of laparoscopic vs. open resection of gastric gastrointestinal stromal tumors |journal=PLoS ONE |volume=12 |issue=5 |pages=e0177193 |year=2017 |pmid=28486486 |pmc=5423634 |doi=10.1371/journal.pone.0177193 |url=}}</ref>
 
**[[Symptomatic]] [[Patient|patients]] with locally advanced [[disease]].
Those with primary GIST who do not have evidence of metastasis.
**Large [[lesions]] and [[tumors]] that are technically resectable if the risks of [[morbidity]] are acceptable.
Those with tumors that are technically resectable if the risks of morbidity are acceptable.
 
In the surgical treatment of GIST, the goal is complete gross resection with an intact pseudocapsule and negative microscopic margins.[4] Because lymph node metastasis is rare with GIST, lymphadenectomy of clinically uninvolved nodes is not necessary.


Although a prospective, randomized trial studying the role of laparoscopic surgery in the management of GIST has not been performed, several studies, listed below, indicate a role for this surgical approach with gastric tumors:
* Surgical [[resection]] of GIST include complete gross resection with an intact pseudocapsule and negative [[microscopic]] margins.
* The GIST are highly [[vascular]] [[tumors]] and have a very fragile pseudocapsule and therefore the surgeon must be really careful regarding the risk of [[tumor]] rupture and subsequent [[peritoneal]] dissemination.
* In GIST, [[lymph node]] [[metastasis]] is rare and therefore [[lymphadenectomy]] and extensive [[lymph node]] exploration is rarely required.


* Most small GISTs (<5 and especially <2 cm) with a low rate of [[mitosis]] (<5 dividing cells per 50 high-power fields) are [[benign]] and,after surgery, do not require [[adjuvant therapy]].
* Most small GISTs (<5 and especially <2 cm) with a low rate of [[mitosis]] (<5 dividing cells per 50 high-power fields) are [[benign]] and, after surgery, do not require [[adjuvant therapy]] with [[tyrosine kinase inhibitors]].


* Larger GISTs (>5 cm), and especially when the cell division rate is high (>6 [[mitosis|mitoses]]/50 HPF), may disseminate and/or recur.
* Larger GISTs (>5 cm), and especially when the [[Cell (biology)|cell]] division rate is high (>6 [[mitosis|mitoses]]/50 HPF), may disseminate with surgery and/or recur and additionally may be treated with [[tyrosine kinase inhibitors]].<ref>{{Cite web | title =Gastrointestinal Stromal Tumors Treatment
| url =http://www.cancer.gov/types/soft-tissue-sarcoma/hp/gist-treatment-pdq#section/_35}}</ref>
**Previously GIST were resistant to conventional [[chemotherapy]] and had a mere success rate of <5%.
**With the advent of ''[[c-kit]]'' [[Protein kinase inhibitor|tyrosine kinase inhibitor]] such as [[imatinib]], the response rate has gone up from 5% to 40-70% in [[Metastasis|metastatic]] or inoperable cases.


* Until recently, GISTs were notorious for being resistant to [[chemotherapy]], with a success rate of <5%. Recently, the ''c-kit'' [[tyrosine kinase]] inhibitor [[imatinib]], a drug initially marketed for [[chronic myelogenous leukemia]], was found to be useful in treating GISTs, leading to a 40-70% response rate in metastatic or inoperable cases.
* Patients who become refractory on imatinib may respond to the multiple tyrosine kinase inhibitor [[sunitinib]] (marketed as Sutent).
==References==
==References==
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{{reflist|2}}
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Latest revision as of 01:31, 4 March 2019


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]Parminder Dhingra, M.D. [3]

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Overview

The mainstay of treatment for gastrointestinal stromal tumor (GIST) is surgical resection. Surgical resection offers an opportunity to completely cure GIST. Laparoscopic and endoscopic resection are the most preferred route of surgery. Surgical resection of GIST include complete gross resection with an intact pseudocapsule and negative microscopic margins.

Surgical Therapy

Surgery is the definitive therapy and typically the initial therapy for patients of gastrointestinal stromal tumor (GIST).

References

  1. Liang JW, Zheng ZC, Zhang JJ, Zhang T, Zhao Y, Yang W, Liu YQ (2013). "Laparoscopic versus open gastric resections for gastric gastrointestinal stromal tumors: a meta-analysis". Surg Laparosc Endosc Percutan Tech. 23 (4): 378–87. doi:10.1097/SLE.0b013e31828e3e9d. PMID 23917593.
  2. DE Vogelaere K, VAN DE Winkel N, Simoens C, Delvaux G (2013). "Intragastric SILS for GIST, a new challenge in oncologic surgery: first experiences". Anticancer Res. 33 (8): 3359–63. PMID 23898104. Vancouver style error: missing comma (help)
  3. De Vogelaere K, Hoorens A, Haentjens P, Delvaux G (2013). "Laparoscopic versus open resection of gastrointestinal stromal tumors of the stomach". Surg Endosc. 27 (5): 1546–54. doi:10.1007/s00464-012-2622-8. PMID 23233005.
  4. Ye L, Wu X, Wu T, Wu Q, Liu Z, Liu C, Li S, Chen T (2017). "Meta-analysis of laparoscopic vs. open resection of gastric gastrointestinal stromal tumors". PLoS ONE. 12 (5): e0177193. doi:10.1371/journal.pone.0177193. PMC 5423634. PMID 28486486.
  5. "Gastrointestinal Stromal Tumors Treatment".


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