Hepatectomy for liver metastasis from gastrointestinal stromal tumor in the era of imatinib mesylate: a case series study

• Published in: International cancer conference journal Vol. 6; no. 3; pp. 121 - 125
• Main Authors: Kawamura, Norio, Kamiyama, Toshiya, Yokoo, Hideki, Kakisaka, Tatsuhiko, Orimo, Tatsuya, Wakayama, Kenji, Tsuruga, Yosuke, Kamachi, Hirofumi, Hatanaka, Kanako, Taketomi, Akinobu
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.07.2017; Springer Nature B.V
• Subjects: c-Kit protein; Case Report; Gastrointestinal cancer; Gastrointestinal surgery; Hepatectomy; Imatinib; Liver; Medical prognosis; Medicine; Medicine & Public Health; Mesentery; Metastases; Metastasis; Mutation; Oncology; Patients; Prognosis; Risk factors; Small intestine; Statistical analysis; Stomach; Surgery; Surgical Oncology; Tumors; Metastatic GIST; Imatinib mesylate; Gastrointestinal stromal tumor; Hepatectomy
• ISSN: 2192-3183; 2192-3183
• DOI: 10.1007/s13691-017-0289-7

The prognosis of metastatic gastrointestinal stromal tumor (GIST) has improved since the introduction of imatinib mesylate; however, acquired resistance has been reported, so alternative treatment option is needed. We evaluated the efficacy of hepatectomy for metastatic GIST. Six patients with liver metastases from GIST underwent hepatectomy. Four were treated with imatinib mesylate before hepatectomy, and all the patients were treated with imatinib mesylate after hepatectomy. Patients were followed-up for a mean duration of 113.5 months after hepatectomy. Complete resection was accomplished in four patients, with incomplete resection performed in the remaining two patients due to peritoneal dissemination. One patient with incomplete resection died 10 months after surgery. One patient with complete resection has survived without disease progression since initial hepatectomy. The remaining four patients with progressive disease during imatinib mesylate treatment developed tumor recurrence and three of them underwent a second hepatectomy. These three patients underwent complete resection during repeat surgery. In total, three patients died during the follow-up period, all of whom had tumors of small intestine origin. Primary tumor site (small intestine vs. others) was identified as a risk factor of mortality ( P  = 0.02). Although not statistically significant, there was a trend toward better outcomes in patients with exon 11 mutations. Surgical resection for metastatic GIST was shown to be effective and needed to achieve a better prognosis. Repeat hepatectomy demonstrated efficacy in selected patients. Hepatectomy should be considered based on tumor characteristics such as primary tumor site and c-KIT mutation status.