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Anorectal gastrointestinal stromal tumors: a retrospective multicenter analysis of 15 cases emphasizing their high local recurrence rate and the need for standardized therapeutic approach

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

This study aims to report our multicenter experience with diagnosis, management, and prognosis of anorectal gastrointestinal stromal tumors (GIST).

Patients and methods

We retrospectively reviewed cases treated and/or followed up at our institutions in the period 2000–2011.

Results

Fifteen patients were identified (eight men and seven women; mean age, 55 years). Presenting symptoms were rectal/perirectal (eight), rectovaginal space (four), or retrovesical/prostatic (three) mass. Primary surgical treatment was local excision (six), deep anterior resection (eight), and palliative diagnostic excision (one). Tumor mean size was 4.8 cm. All but two cases were high risk (Miettinen and Lasota, Semin Diagn Pathol 23:70–83, 2006). R0 resection was achieved in 46 % of cases: one of six local excisions vs. five of seven deep anterior resection (16 vs. 71 %, respectively). All three cases who received total mesorectal excision had R0. Non-R0 status was mainly due to opening of tumor capsule at surgery (Rx). Seven of 14 patients (50 %) developed ≥1 pelvic local recurrences at a mean period of 48.4 months (mean follow-up, 61.6 months). Only two patients developed distant metastasis (adrenal, liver, and peritoneal). Recurrences developed after Rx (three), R1 (two), and unknown R-status (two). Successful mutational analysis in 13 patients revealed KIT mutations in all (10 exon 11, 2 exon 9, and 1 exon 13).

Conclusion

Our results confirm the high local recurrence rate of anorectal GISTs (50 %) which correlates with the common practice of suboptimal oncological primary tumor resection (Rx or R1 = 7/13). This uncommon subset of GISTs needs more standardized oncological surgical approach to minimize the propensity for local disease recurrence.

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Authors and Affiliations

  1. Institute of Pathology, University Hospital Erlangen, Krankenhausstraße 8-10, 91054, Erlangen, Germany

    Abbas Agaimy, Florian Haller & Regine Schneider-Stock

  2. Department of Surgery, University Hospital Erlangen, Erlangen, Germany

    Nikolaos Vassos, Werner Hohenberger, Roland S. Croner & Klaus Matzel

  3. Institute of Pathology, Klinikum Augsburg, Augsburg, Germany

    Bruno Märkl

  4. Medical Clinic-5, University Hospital Erlangen, Erlangen, Germany

    Norbert Meidenbauer

  5. Department of Surgery, Klinikum Nürnberg, Nürnberg, Germany

    Jens Köhler

  6. Department of General-Visceral and Transplantation Surgery, Klinikum Augsburg, Augsburg, Germany

    Johann Spatz

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  1. Abbas Agaimy
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  2. Nikolaos Vassos
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Correspondence to Abbas Agaimy.

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Agaimy, A., Vassos, N., Märkl, B. et al. Anorectal gastrointestinal stromal tumors: a retrospective multicenter analysis of 15 cases emphasizing their high local recurrence rate and the need for standardized therapeutic approach. Int J Colorectal Dis 28, 1057–1064 (2013). https://doi.org/10.1007/s00384-013-1655-3

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  • DOI: https://doi.org/10.1007/s00384-013-1655-3

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