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

الملخص EN

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.