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Incidental Finding of Gastrointestinal Stromal Tumors during Laparoscopic Sleeve Gastrectomy in Obese Patients

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Abstract

Introduction

The frequency of incidental pathology found during laparoscopic bariatric surgery has been estimated to be 2%. Gastrointestinal stromal tumors (GISTs) are infrequent lesions and account for less than 1% of all digestive tract tumors. The reported incidence of this type of tumors during bariatric surgery is around 0.8%. The objective of this study was to evaluate incidence, characteristics, and evolution of incidentally found GISTs in patients undergoing laparoscopic sleeve gastrectomy (LSG) for the treatment of obesity.

Material and Methods

A retrospective analysis from a prospectively collected database was conducted. Demographic data, clinical data, laboratory tests, preoperative esophagogastroduodenoscopy (EGD), postoperative pathology report from surgical specimen with tumor markers, and patient’s outcomes were evaluated.

Results

From June 2006 to January 2014, 915 patients underwent LSG at our institution. Five (0.5%) patients were found to have incidental GIST. There were four (80%) women; average age was 59.6 ± 6.3 years (range 46–63). None of them had symptoms that served as orientation for preoperative diagnosis. EGD findings were non-suggestive of this pathology in any of these cases. Superficial chronic gastritis was the most common finding in the endoscopic biopsy (60%). All the tumors found in the surgical specimen were of low or very low risk of malignancy, with less than 5 mitoses per 50 fields, less than 2 cm in diameter, and disease-free surgical margins. Cluster of differentiation (CD) 117 and CD 34 were positive in 100% of the cases. None of the patients required adjuvant therapy after the surgery. At 5-year follow-up, all patients were asymptomatic and disease free.

Conclusion

The incidence of unsuspected GIST in LSG specimens in our series was low and similar to what has been reported. The lack of symptoms and the preoperative EGD findings were not suggestive of this diagnosis in any case. The degree of tumor malignancy was low in all patients and LSG was the definitive treatment, without recurrence at 5-year follow-up.

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References

  1. Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142:547–59.

    Article  PubMed  Google Scholar 

  2. ASMBS Clinical Issues Committee. Updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis. 2012;8:e21–6.

    Article  Google Scholar 

  3. Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis. 2009;5:469–75.

    Article  PubMed  Google Scholar 

  4. Arias E, Martínez PR, Ka Ming Li V, et al. Mid-term follow-up after sleeve gastrectomy as a final approach for morbid obesity. Obes Surg. 2009;19:544–8.

    Article  PubMed  Google Scholar 

  5. Gumbs AA, Gagner M, Dakin G, et al. Sleeve gastrectomy for morbid obesity. Obes Surg. 2007;17:962–9.

    Article  PubMed  Google Scholar 

  6. Boza C, Salinas J, Salgado N, et al. Laparoscopic sleeve gastrectomy as a stand-alone procedure for morbid obesity: report of 1,000 cases and 3-year follow-up. Obes Surg. 2012;22:866–71.

    Article  PubMed  Google Scholar 

  7. Finnell CW, Madan AK, Ternovits CA, et al. Unexpected pathology during laparoscopic bariatric surgery. Surg Endosc. 2007;21:867–9.

    Article  CAS  PubMed  Google Scholar 

  8. Beltran MA, Pujado B, Méndez PE, et al. Gastric gastrointestinal stromal tumor (GIST) incidentally found and resected during laparoscopic sleeve gastrectomy. Obes Surg. 2010;20:393–6.

    Article  PubMed  Google Scholar 

  9. Raghavendra RS, Kini D. Benign, premalignant, and malignant lesions encountered in bariatric surgery. JSLS. 2012;16:360–72.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Nishida T, Hirota S, Yanagisawa A, et al. Clinical practice guidelines for gastrointestinal stromal tumor (GIST) in Japan: English version. Int J Clin Oncol. 2008;13:416–30.

    Article  PubMed  Google Scholar 

  11. Sanchez BR, Morton JM, Curet MJ, et al. Incidental finding of gastrointestinal stromal tumors (GISTs) during laparoscopic gastric bypass. Obes Surg. 2005;15:1384–8.

    Article  PubMed  Google Scholar 

  12. Yun HY, Sung R, Kim YC, et al. Regional distribution of interstitial cells of Cajal (ICC) in human stomach. Korean J Physiol Pharmacol. 2010;14:317–24.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Duffaud F, Blay JY. Gastrointestinal stromal tumors: biology and treatment. Oncology. 2003;65:187–97.

    Article  PubMed  Google Scholar 

  14. Otani Y, Furukawa T, Yoshida M, et al. Operative indications for relatively small (2-5 cm) gastrointestinal stromal tumor of the stomach based on analysis of 60 operated cases. Surgery. 2006;139:484–92.

    Article  PubMed  Google Scholar 

  15. Van der Zwan SM, DeMatteo RP. Gastrointestinal stromal tumor: 5 years later. Cancer. 2005;104:1781–8.

    Article  CAS  PubMed  Google Scholar 

  16. Privette A, McCahill L, Borrazzo E, et al. Laparoscopic approaches to resection of suspected gastric gastrointestinal stromal tumors based on tumor location. Surg Endosc. 2008;22:487–94.

    Article  CAS  PubMed  Google Scholar 

  17. Basu S, Balaji S, Bennett DH, et al. Gastrointestinal stromal tumors (GIST) and laparoscopic resection. Surg Endosc. 2007;21:1685–9.

    Article  PubMed  Google Scholar 

  18. Nishimura J, Nakajima K, Omori T, et al. Surgical strategy for gastric gastrointestinal stromal tumors: laparoscopic vs. open resection. Surg Endosc. 2007;21:875–8.

    Article  PubMed  Google Scholar 

  19. Nguyen SQ, Divino CM, Wang JL, et al. Laparoscopic management of gastrointestinal stromal tumors. Surg Endosc. 2006;20:713–6.

    Article  CAS  PubMed  Google Scholar 

  20. De Vogelaere K, Van Loo I, Peters O, et al. Laparoscopic resection of gastric gastrointestinal stromal tumors (GIST) is safe and effective, irrespective of tumor size. Surg Endosc. 2012;26:2339–45.

    Article  CAS  PubMed  Google Scholar 

  21. Chiappetta S, Theodoridou S, Stier C, et al. Incidental finding of GIST during obesity surgery. Obes Surg. 2015;25:579–83.

    Article  PubMed  Google Scholar 

  22. de Roover A, Detry O, de Leval L, et al. Report of two cases of gastric cancer after bariatric surgery: lymphoma of the bypassed stomach after Roux-en-Y gastric bypass and gastrointestinal stromal tumor (GIST) after vertical banded gastroplasty. Obes Surg. 2006;16:928–31.

    Article  PubMed  Google Scholar 

  23. Antonopoulos P, Leonardou P, Barbagiannis N, et al. Gastrointestinal and extragastrointestinal stromal tumors: report of two cases and review of the literature. Case Rep Gastroenterol. 2014;8:61–6.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Eisenberg BL, Judson I. Surgery and imatinib in the management of GIST: emerging approaches to adjuvant and neoadjuvant therapy. Ann Surg Oncol. 2004;11:465–75.

    Article  PubMed  Google Scholar 

  25. Greenbaum D, Friedel D. Unanticipated findings at bariatric surgery. Surg Obes Relat Dis. 2005;1:22–4.

    Article  PubMed  Google Scholar 

  26. Wang Y, Liu J. Laparoscopic sleeve gastrectomy in the treatment of gastrointestinal stroma tumours in morbid obese patients. BMJ Case Rep. 2009;2009. doi:10.1136/bcr.06.2008.0204.

  27. Csendes A, Burgos AM, Smok G, et al. Endoscopic and histologic findings of the foregut in 426 patients with morbid obesity. Obes Surg. 2007;17:28–34.

    Article  PubMed  Google Scholar 

  28. Muñoz R, Ibáñez L, Salinas J, et al. Importance of routine preoperative upper GI endoscopy: why all patients should be evaluated? Obes Surg. 2009;19:427–31.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. General Surgery Department, Bariatric Surgery Program, Hospital Privado Centro Médico de Córdoba, Naciones Unidas 346, 5016, Córdoba, Argentina

    Germán Viscido, Franco Signorini, Luciano Navarro, Mario Campazzo, Patricia Saleg, Lucio Obeide & Federico Moser

  2. Programa de Unidades Bariatricas, Las Heras 3515, 8vo B, Buenos Aires, Argentina

    Verónica Gorodner

Authors
  1. Germán Viscido
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  2. Franco Signorini
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  3. Luciano Navarro
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  4. Mario Campazzo
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  5. Patricia Saleg
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  6. Verónica Gorodner
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  7. Lucio Obeide
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  8. Federico Moser
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Correspondence to Franco Signorini.

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The authors declare that they have no competing interests.

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Viscido, G., Signorini, F., Navarro, L. et al. Incidental Finding of Gastrointestinal Stromal Tumors during Laparoscopic Sleeve Gastrectomy in Obese Patients. OBES SURG 27, 2022–2025 (2017). https://doi.org/10.1007/s11695-017-2583-z

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  • DOI: https://doi.org/10.1007/s11695-017-2583-z

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