Gastrointestinal stromal tumor (gist)’s surgical treatment, nci experience

• Published in: Journal of Egyptian National Cancer Institute Vol. 17; no. 2; pp. 56 - 66
• Main Authors: al-Shahway, Majdi, Fakhr, Ibrahim, Khalil, al-Sayyid Ashraf, al-Zohairy, Muhammad, Jawdah, Iman A.
• Format: Journal Article
• Language: English
• Published: Cairo, Egypt Cairo University, National Cancer Institute 2005
• Subjects: Adult; Aged; Aged, 80 and over; Female; Gastrointestinal Stromal Tumors - diagnosis; Gastrointestinal Stromal Tumors - mortality; Gastrointestinal Stromal Tumors - pathology; Gastrointestinal Stromal Tumors - surgery; Gastrointestinal system; Humans; Male; Middle Aged; Prognosis; Surgery; Survival Rate; Tumors; الأورام; الجراحة
• ISSN: 1110-0362; 1687-9996

Purpose : To review the clinical presentation, surgical management, and prognostic factors for gastrointestinal stromal tumors. Patients and Methods : A prospective study which was carried out between January 2002 and March 2004 on thirty-three patients with gastrointestinal stromal tumor (GIST) at the National Cancer Institute, Cairo University. All patients were evaluated preoperatively and underwent exploratory laparotomy with a curative intent, they were followed up for period ranging between 14-35 months. Results : Among the 33 patients there were 17 males and 16 females. The mean age of patients was 52.8 years. Clinical findings included gastrointestinal bleeding (42.4 %), palpable mass (33.3 %) and abdominal pain (24.3 %). The stomach was the most common site of origin of the disease (39.4 %), followed by the colorectal region (24.2 %). Tumors were high grade in 63.6 % of patients and low-grade in 36.4 % of patients. Complete resection of all gross disease was accomplished in 26 patients (78.7 %), among whom, multiple adjacent organ resection was required in 6 patients (22.2 %) and metastatic disease was identified in the liver in 3 patients at the time of exploratory surgery of these one could be resected. Immunohistochemical staining for CD117 was positive in 88.9 % of patients. The median follow-up period was 20 months (range, 14-35 months). The overall median survival in this study was 25 months, and the cumulative survival at 30 months was 46.9 %. Unfavorable prognostic factors were incomplete resection and, high-grade histological features (p < 0.05). None of the patients received adjuvant or palliative chemotherapy. Twenty six patients (78.8 %) are alive free of disease. Of the 7 patients with incomplete resections or biopsy only ; 4 patients (12.1 %) are alive with disease and 3 patients died. Conclusion : Surgical resection, including en bloc resection of locally advanced tumors, remains the only curative treatment. Overall survival is significantly affected by high-grade tumors and positive resection margin.