Outcome After Curative Resection of Large (≥10 cm) Gastric Gastrointestinal Stromal Tumors: How Frequent is Adjacent Organ Involvement and is Concomitant Distal Pancreatectomy Necessary?
- 85 Downloads
Complete tumor resection with clear margins including adjacent organs is the treatment of choice for gastrointestinal stromal tumors (GISTs). However, true tumor invasion of adjacent organs has been reported to be rare. Concomitant distal pancreatectomy (DP) for suspected tumor infiltration is not infrequently performed during resection of large gastric GISTs. This study aims to determine the true frequency of adjacent organ involvement by large gastric GISTs with particular attention to the pancreas and compares the outcome after curative resection with and without a concomitant DP in order to determine if DP is truly necessary.
A retrospective review of 37 patients who underwent curative resection of large (≥10 cm) gastric GISTs was conducted.
Wedge resections were performed in 22, partial gastectomies in nine, and total gastrectomies in six patients. The median operative time was 180 min (range, 60–330 min), and the patients had a median postoperative stay of 8 days (range, 4–29 days). Overall, there were eight (22%) morbidities including two (5%) mortalities. Nineteen (51%) had concomitant adjacent organ resection, and these included 15 (41%) DPs with splenectomies. Direct organ invasion was demonstrated in 5/19 patients (26%) and 7/30 organs (23%) resected. Only 1/15 (6.7%) DP specimens demonstrated tumor infiltration. Comparison between the patients with and without a concomitant DP demonstrated that performance of a DP was associated with a longer operation time [225 min (range, 105–305 min) vs 158 min (60–330 min), P = .002)], increased postoperative stay [9 days (range, 7–29 days) vs 7.5 days (4–19 days), P = .042], and increased postoperative morbidity [6 (40%) vs 2 (9%), P = .025]. The DP cohort also had a statistically significant poorer 5-year recurrence free survival (22% vs 60%, P = .017).
Although adjacent organ involvement is not uncommon with large gastric GISTs, concomitant DP is usually unnecessary as direct pancreatic invasion is rare. Furthermore, concomitant DP with splenectomy is associated with an increase in postoperative morbidity.
KeywordsGastrointestinal stromal tumor GIST Gastric Pancreatectomy Surgery Large
- 6.Goh BK, Chow PK, Yap WM, Kesavan SM, Song IC, Paul PG, Ooi BS, Chung YF, Wong WK. Which is the optimal risk stratification system for surgically treated localize primary GIST? Comparison of three contemporary prognostic criteria in 171 tumors and a proposal of a modified Armed Forces Institute of Pathology risk criteria. Ann Surg Oncol 2008;15:2153–2163.CrossRefPubMedGoogle Scholar
- 9.Fujimoto Y, Nakanishi Y, Yoshimura K, Shimoda T. Clinicopathologic study of primary malignant gastrointestinal stromal tumor of the stomach, with special reference to prognostic factors: analysis of results in 140 surgically resected patients. Gastric Cancer 2003;6:39–48.CrossRefPubMedGoogle Scholar
- 10.Goh BK, Tan YM, Chung YF, Cheow PC, Ong HS, Chan WH, Chow PK, Soo KC, Wong WK, Ooi LL. Critical appraisal of 232 consecutive distal pancreatectomies with emphasis on risk factors, outcome and management of the postoperative pancreatic fistula. A 21-year experience at a single institution. Arch Surg 2008;143:956–965.CrossRefPubMedGoogle Scholar