Gastrointestinal Stromal Tümörlerin Kliniko-patolojik ve Cerrahi Özellikleri: 13 yıllık 3.Basamak Merkezi Deneyimi ve Literatür Derlemesi
Year 2023,
Volume: 13 Issue: 1, 166 - 170, 16.03.2023
Emrah Akın
,
Ahmet Tarık Harmantepe
,
Zeynep Kahyaoğlu Akkaya
,
Necattin Fırat
,
Merve Yiğit
,
Recayi Capoglu
,
Fatih Altıntoprak
Abstract
Amaç: Gastrointestinal stromal tümörler (GIST) sindirim sisteminin en sık görülen mezenkimal kaynaklı tümörleridir. Bu çalışmada cerrahi tedavi uygulanmış olan GIST hastalarının erken dönem cerrahi sonuçları sunulmaktadır.
Materyal-Metod: Sakarya Üniversitesi Eğitim Araştırma Hastanesi Genel Cerrahi Kliniğinde 2008-2021 tarihleri arasında opere edilen ve histopatolojik olarak GIST tanısı doğrulanan hastaların sonuçları retrospektif olarak incelendi. Hastalar demografik veriler, klinik-patolojik özellikleri ve erken dönem cerrahi sonuçları açılarından ayrıntılı olarak değerlendirildi.
Bulgular: Ameliyat edilen 55 hastanın E/K oranı 3/2, yaş ortalaması 57.82 yıl (45-81 yıl) idi. Karın ağrısı (37 hasta - %67.2) en sık başvuru şikayetiydi. Mide (37 hasta - %67.2) en sık etkilenen organdı. CD117 pozitifliği 53 hastada (%96.3) oranında görüldü ve Ulusal Sağlık Enstitüsü (NIH) kategorisine göre hastaların %56.6’sı yüksek risk sınıfı olarak kategorize edildi. 52 hastaya (%94.6) primer cerrahi rezeksiyon uygulandı. En sık açık ameliyat 40 hastada (%72,7) tercih edildi, çalışmanın son 6 yılı için ise açık/laparoskopi tercih edilme oranı 1/1 olarak belirlendi. Segmental rezeksiyon 29 hastayla (%52,7) açık veya laparoskopik en sık uygulanan rezeksiyon tipi idi. Tümör boyutları ortalama 7.03 cm (1-18 cm), ortalama hastanede yatış süresi 10.44 gün (5-45 gün) idi, enterokütan fistül gelişen bir hasta çalışma dışı bırakıldığında ise ortalama hastane yatış süresi 8.2 gün (5-19 gün) olarak belirlendi.
Sonuç: GIST, uygun endikasyonlarda açık veya laparoskopik teknikle primer tedavi şekli komplet cerrahi rezeksiyon olarak deneyimli kliniklerde kabul edilebilir komplikasyon oranlarıyla güvenle tedavi edilebilir.
References
- Nilsson B, Bümming P, Meis-Kindblom JM, et al. Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era--a population-based study in western Sweden. Cancer. 2005;103(4):821-829. doi:10.1002/cncr.20862
- Zhao WY, Zhao G, Wang M. [Updates and interpretations of the NCCN Clinical Practice Guidelines (2019 6th version) on gastrointestinal stromal tumor]. Zhonghua Wei Chang Wai Ke Za Zhi Chin J Gastrointest Surg. 2020;23(9):866-871. doi:10.3760/cma.j.cn.441530-20200731-00454
- Demetri GD, von Mehren M, Antonescu CR, et al. NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Cancer Netw JNCCN. 2010;8 Suppl 2:S1-41; quiz S42-44. doi:10.6004/jnccn.2010.0116
- Tan CB, Zhi W, Shahzad G, Mustacchia P. Gastrointestinal stromal tumors: a review of case reports, diagnosis, treatment, and future directions. ISRN Gastroenterol. 2012;2012:595968. doi:10.5402/2012/595968
- Jung ES, Kang YK, Cho MY, et al. Update on the proposal for creating a guideline for cancer registration of the gastrointestinal tumors (I-2). Korean J Pathol. 2012;46(5):443-453. doi:10.4132/KoreanJPathol.2012.46.5.443
- Patil DT, Rubin BP. Gastrointestinal stromal tumor: advances in diagnosis and management. Arch Pathol Lab Med. 2011;135(10):1298-1310. doi:10.5858/arpa.2011-0022-RA
- Søreide K, Sandvik OM, Søreide JA, Giljaca V, Jureckova A, Bulusu VR. Global epidemiology of gastrointestinal stromal tumours (GIST): A systematic review of population-based cohort studies. Cancer Epidemiol. 2016;40:39-46. doi:10.1016/j.canep.2015.10.031
- Ducimetière F, Lurkin A, Ranchère-Vince D, et al. Incidence of sarcoma histotypes and molecular subtypes in a prospective epidemiological study with central pathology review and molecular testing. PloS One. 2011;6(8):e20294. doi:10.1371/journal.pone.0020294
- Mazur MT, Clark HB. Gastric stromal tumors. Reappraisal of histogenesis. Am J Surg Pathol. 1983;7(6):507-519. doi:10.1097/00000478-198309000-00001
- Tryggvason G, Gíslason HG, Magnússon MK, Jónasson JG. Gastrointestinal stromal tumors in Iceland, 1990-2003: the icelandic GIST study, a population-based incidence and pathologic risk stratification study. Int J Cancer. 2005;117(2):289-293. doi:10.1002/ijc.21167
- Demetri GD, Benjamin R, Blanke CD, et al. NCCN Task Force report: optimal management of patients with gastrointestinal stromal tumor (GIST)--expansion and update of NCCN clinical practice guidelines. J Natl Compr Cancer Netw JNCCN. 2004;2 Suppl 1:S-1-26; quiz 27-30.
- Alessandrino F, Tirumani SH, Jagannathan JP, Ramaiya NH. Imaging surveillance of gastrointestinal stromal tumour: current recommendation by National Comprehensive Cancer Network and European Society of Medical Oncology-European Reference Network for rare adult solid cancers. Clin Radiol. 2019;74(10):746-755. doi:10.1016/j.crad.2019.06.015
- Joensuu H, Hohenberger P, Corless CL. Gastrointestinal stromal tumour. Lancet Lond Engl. 2013;382(9896):973-983. doi:10.1016/S0140-6736(13)60106-3
- Gold JS, Gönen M, Gutiérrez A, et al. Development and validation of a prognostic nomogram for recurrence-free survival after complete surgical resection of localised primary gastrointestinal stromal tumour: a retrospective analysis. Lancet Oncol. 2009;10(11):1045-1052. doi:10.1016/S1470-2045(09)70242-6
- Kit OI, Gevorkyan YA, Kolesnikov EN, Soldatkina NV, Dashkov AV, Kolesnikov VE. [Gastrointestinal stromal tumors: potential of minimally invasive surgical interventions]. Khirurgiia (Sofiia). 2022;(5):25-33. doi:10.17116/hirurgia202205125
- Mu M, Cai Z, Liu C, et al. Open and minimally invasive surgery for gastrointestinal stromal tumours: a systematic review and network meta-analysis protocol. BMJ Open. 2022;12(2):e050414. doi:10.1136/bmjopen-2021-050414
- Stanciulea O, Ionescu MI, Blanita D, Lacatus M, Gheorghe C, Vasilescu C. Minimal Access Surgery for the Treatment of Gastric Gastrointestinal Stromal Tumours - A Single Centre Experience. Chir Buchar Rom 1990. 2020;115(6):726-734. doi:10.21614/chirurgia.115.6.726
- Yu Z, Tu H, Liang C, et al. Therapeutic Effects of 4 Surgical Approaches for Small Gastrointestinal Stromal Tumors: A Network Meta-analysis. Surg Laparosc Endosc Percutan Tech. 2022;32(5):606-615. doi:10.1097/SLE.0000000000001076
- Pulido J, Garavito J, Franco L, et al. Laparoendoscopic surgery for the treatment of gastrointestinal stromal tumors: A case series. Cir Cir. 2022;90(S1):121-126. doi:10.24875/CIRU.21000649
- Open versus laparoscopic versus robotic gastric gastrointestinal stromal tumour resections: A multicentre cohort study - PubMed. Accessed November 6, 2022. https://pubmed.ncbi.nlm.nih.gov/33131156/
- Lim KT. Surgical treatment of gastrointestinal stromal tumors of the stomach: current status and future perspective. Transl Gastroenterol Hepatol. 2017;2:104. doi:10.21037/tgh.2017.12.01
- Wakamatsu K, Lo Menzo E, Szomstein S, Seto Y, Chalikonda S, Rosenthal RJ. Feasibility of Laparoscopic Resection of Gastrointestinal Stromal Tumor of the Stomach. J Laparoendosc Adv Surg Tech A. 2018;28(5):569-573. doi:10.1089/lap.2017.0564
- De Vogelaere K, Hoorens A, Haentjens P, Delvaux G. Laparoscopic versus open resection of gastrointestinal stromal tumors of the stomach. Surg Endosc. 2013;27(5):1546-1554. doi:10.1007/s00464-012-2622-8
- Xu C, Chen T, Hu Y, et al. Retrospective study of laparoscopic versus open gastric resection for gastric gastrointestinal stromal tumors based on the propensity score matching method. Surg Endosc. 2017;31(1):374-381. doi:10.1007/s00464-016-4983-x
- Miettinen M, Lasota J. Gastrointestinal stromal tumors: review on morphology, molecular pathology, prognosis, and differential diagnosis. Arch Pathol Lab Med. 2006;130(10):1466-1478. doi:10.5858/2006-130-1466-GSTROM
- Casali PG, Abecassis N, Aro HT, et al. Gastrointestinal stromal tumours: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol Off J Eur Soc Med Oncol. 2018;29(Suppl 4):iv267. doi:10.1093/annonc/mdy320
- Joensuu H, Eriksson M, Sundby Hall K, et al. Adjuvant Imatinib for High-Risk GI Stromal Tumor: Analysis of a Randomized Trial. J Clin Oncol Off J Am Soc Clin Oncol. 2016;34(3):244-250. doi:10.1200/JCO.2015.62.9170
- Rutkowski P, Gronchi A, Hohenberger P, et al. Neoadjuvant imatinib in locally advanced gastrointestinal stromal tumors (GIST): the EORTC STBSG experience. Ann Surg Oncol. 2013;20(9):2937-2943. doi:10.1245/s10434-013-3013-7
- Date RS, Stylianides NA, Pursnani KG, Ward JB, Mughal MM. Management of gastrointestinal stromal tumours in the Imatinib era: a surgeon’s perspective. World J Surg Oncol. 2008;6:77. doi:10.1186/1477-7819-6-77
- Tu L, Hohenberger P, Allgayer H, Cao H. Standard Approach to Gastrointestinal Stromal Tumors - Differences between China and Europe. Visc Med. 2018;34(5):353-358. doi:10.1159/000494347
- Koo DH, Ryu MH, Kim KM, et al. Asian Consensus Guidelines for the Diagnosis and Management of Gastrointestinal Stromal Tumor. Cancer Res Treat. 2016;48(4):1155-1166. doi:10.4143/crt.2016.187
Year 2023,
Volume: 13 Issue: 1, 166 - 170, 16.03.2023
Emrah Akın
,
Ahmet Tarık Harmantepe
,
Zeynep Kahyaoğlu Akkaya
,
Necattin Fırat
,
Merve Yiğit
,
Recayi Capoglu
,
Fatih Altıntoprak
References
- Nilsson B, Bümming P, Meis-Kindblom JM, et al. Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era--a population-based study in western Sweden. Cancer. 2005;103(4):821-829. doi:10.1002/cncr.20862
- Zhao WY, Zhao G, Wang M. [Updates and interpretations of the NCCN Clinical Practice Guidelines (2019 6th version) on gastrointestinal stromal tumor]. Zhonghua Wei Chang Wai Ke Za Zhi Chin J Gastrointest Surg. 2020;23(9):866-871. doi:10.3760/cma.j.cn.441530-20200731-00454
- Demetri GD, von Mehren M, Antonescu CR, et al. NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Cancer Netw JNCCN. 2010;8 Suppl 2:S1-41; quiz S42-44. doi:10.6004/jnccn.2010.0116
- Tan CB, Zhi W, Shahzad G, Mustacchia P. Gastrointestinal stromal tumors: a review of case reports, diagnosis, treatment, and future directions. ISRN Gastroenterol. 2012;2012:595968. doi:10.5402/2012/595968
- Jung ES, Kang YK, Cho MY, et al. Update on the proposal for creating a guideline for cancer registration of the gastrointestinal tumors (I-2). Korean J Pathol. 2012;46(5):443-453. doi:10.4132/KoreanJPathol.2012.46.5.443
- Patil DT, Rubin BP. Gastrointestinal stromal tumor: advances in diagnosis and management. Arch Pathol Lab Med. 2011;135(10):1298-1310. doi:10.5858/arpa.2011-0022-RA
- Søreide K, Sandvik OM, Søreide JA, Giljaca V, Jureckova A, Bulusu VR. Global epidemiology of gastrointestinal stromal tumours (GIST): A systematic review of population-based cohort studies. Cancer Epidemiol. 2016;40:39-46. doi:10.1016/j.canep.2015.10.031
- Ducimetière F, Lurkin A, Ranchère-Vince D, et al. Incidence of sarcoma histotypes and molecular subtypes in a prospective epidemiological study with central pathology review and molecular testing. PloS One. 2011;6(8):e20294. doi:10.1371/journal.pone.0020294
- Mazur MT, Clark HB. Gastric stromal tumors. Reappraisal of histogenesis. Am J Surg Pathol. 1983;7(6):507-519. doi:10.1097/00000478-198309000-00001
- Tryggvason G, Gíslason HG, Magnússon MK, Jónasson JG. Gastrointestinal stromal tumors in Iceland, 1990-2003: the icelandic GIST study, a population-based incidence and pathologic risk stratification study. Int J Cancer. 2005;117(2):289-293. doi:10.1002/ijc.21167
- Demetri GD, Benjamin R, Blanke CD, et al. NCCN Task Force report: optimal management of patients with gastrointestinal stromal tumor (GIST)--expansion and update of NCCN clinical practice guidelines. J Natl Compr Cancer Netw JNCCN. 2004;2 Suppl 1:S-1-26; quiz 27-30.
- Alessandrino F, Tirumani SH, Jagannathan JP, Ramaiya NH. Imaging surveillance of gastrointestinal stromal tumour: current recommendation by National Comprehensive Cancer Network and European Society of Medical Oncology-European Reference Network for rare adult solid cancers. Clin Radiol. 2019;74(10):746-755. doi:10.1016/j.crad.2019.06.015
- Joensuu H, Hohenberger P, Corless CL. Gastrointestinal stromal tumour. Lancet Lond Engl. 2013;382(9896):973-983. doi:10.1016/S0140-6736(13)60106-3
- Gold JS, Gönen M, Gutiérrez A, et al. Development and validation of a prognostic nomogram for recurrence-free survival after complete surgical resection of localised primary gastrointestinal stromal tumour: a retrospective analysis. Lancet Oncol. 2009;10(11):1045-1052. doi:10.1016/S1470-2045(09)70242-6
- Kit OI, Gevorkyan YA, Kolesnikov EN, Soldatkina NV, Dashkov AV, Kolesnikov VE. [Gastrointestinal stromal tumors: potential of minimally invasive surgical interventions]. Khirurgiia (Sofiia). 2022;(5):25-33. doi:10.17116/hirurgia202205125
- Mu M, Cai Z, Liu C, et al. Open and minimally invasive surgery for gastrointestinal stromal tumours: a systematic review and network meta-analysis protocol. BMJ Open. 2022;12(2):e050414. doi:10.1136/bmjopen-2021-050414
- Stanciulea O, Ionescu MI, Blanita D, Lacatus M, Gheorghe C, Vasilescu C. Minimal Access Surgery for the Treatment of Gastric Gastrointestinal Stromal Tumours - A Single Centre Experience. Chir Buchar Rom 1990. 2020;115(6):726-734. doi:10.21614/chirurgia.115.6.726
- Yu Z, Tu H, Liang C, et al. Therapeutic Effects of 4 Surgical Approaches for Small Gastrointestinal Stromal Tumors: A Network Meta-analysis. Surg Laparosc Endosc Percutan Tech. 2022;32(5):606-615. doi:10.1097/SLE.0000000000001076
- Pulido J, Garavito J, Franco L, et al. Laparoendoscopic surgery for the treatment of gastrointestinal stromal tumors: A case series. Cir Cir. 2022;90(S1):121-126. doi:10.24875/CIRU.21000649
- Open versus laparoscopic versus robotic gastric gastrointestinal stromal tumour resections: A multicentre cohort study - PubMed. Accessed November 6, 2022. https://pubmed.ncbi.nlm.nih.gov/33131156/
- Lim KT. Surgical treatment of gastrointestinal stromal tumors of the stomach: current status and future perspective. Transl Gastroenterol Hepatol. 2017;2:104. doi:10.21037/tgh.2017.12.01
- Wakamatsu K, Lo Menzo E, Szomstein S, Seto Y, Chalikonda S, Rosenthal RJ. Feasibility of Laparoscopic Resection of Gastrointestinal Stromal Tumor of the Stomach. J Laparoendosc Adv Surg Tech A. 2018;28(5):569-573. doi:10.1089/lap.2017.0564
- De Vogelaere K, Hoorens A, Haentjens P, Delvaux G. Laparoscopic versus open resection of gastrointestinal stromal tumors of the stomach. Surg Endosc. 2013;27(5):1546-1554. doi:10.1007/s00464-012-2622-8
- Xu C, Chen T, Hu Y, et al. Retrospective study of laparoscopic versus open gastric resection for gastric gastrointestinal stromal tumors based on the propensity score matching method. Surg Endosc. 2017;31(1):374-381. doi:10.1007/s00464-016-4983-x
- Miettinen M, Lasota J. Gastrointestinal stromal tumors: review on morphology, molecular pathology, prognosis, and differential diagnosis. Arch Pathol Lab Med. 2006;130(10):1466-1478. doi:10.5858/2006-130-1466-GSTROM
- Casali PG, Abecassis N, Aro HT, et al. Gastrointestinal stromal tumours: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol Off J Eur Soc Med Oncol. 2018;29(Suppl 4):iv267. doi:10.1093/annonc/mdy320
- Joensuu H, Eriksson M, Sundby Hall K, et al. Adjuvant Imatinib for High-Risk GI Stromal Tumor: Analysis of a Randomized Trial. J Clin Oncol Off J Am Soc Clin Oncol. 2016;34(3):244-250. doi:10.1200/JCO.2015.62.9170
- Rutkowski P, Gronchi A, Hohenberger P, et al. Neoadjuvant imatinib in locally advanced gastrointestinal stromal tumors (GIST): the EORTC STBSG experience. Ann Surg Oncol. 2013;20(9):2937-2943. doi:10.1245/s10434-013-3013-7
- Date RS, Stylianides NA, Pursnani KG, Ward JB, Mughal MM. Management of gastrointestinal stromal tumours in the Imatinib era: a surgeon’s perspective. World J Surg Oncol. 2008;6:77. doi:10.1186/1477-7819-6-77
- Tu L, Hohenberger P, Allgayer H, Cao H. Standard Approach to Gastrointestinal Stromal Tumors - Differences between China and Europe. Visc Med. 2018;34(5):353-358. doi:10.1159/000494347
- Koo DH, Ryu MH, Kim KM, et al. Asian Consensus Guidelines for the Diagnosis and Management of Gastrointestinal Stromal Tumor. Cancer Res Treat. 2016;48(4):1155-1166. doi:10.4143/crt.2016.187