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Objective To investigate the clinical efficacy of endoscopic resection,laparoscopic resection and open resection in the treatment of gastric stromal tumor (GIST).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 254 GIST patients who were admitted to the First Affiliated Hospital of Army Medical University between January 2007 and June 2017 were collected.The endoscopic submucosal dissection (ESD) and laparoscopic or open wedge resection of GIST were performed according to the patients' conditions.Observation indicators:(1) surgical and postoperative recovery situations;(2) postoperative pathological examination;(3) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative adjuvant therapy and survival up to June 2017.Measurement data with normal distribution were represented as-x±s.Measurement data with skewed distribution were described as M (range).Results (1) Surgical and postoperative recovery situations:of 254 patients,112 underwent ESD,including 111 with successful operation and 1 with intraoperative conversion to open surgery due to excessive bleeding-induced blurred operating view,93 underwent successful laparoscopic wedge resection of GIST and 49 underwent successful open wedge resection of GIST.The operation time,volume of intraoperative blood loss,time for initial fluid diet intake,duration of hospital stay and hospital expenses were respectively (75±21) minutes,(6.9±0.5)mL,(2.8±0.9)days,(5.5 ± 0.2)days,(22 167±1 364) yuan in patients with ESD and (137±65) minutes,(48.1±2.6)mL,(3.9±1.4) days,(8.3 ± 2.2)days,(32 937±1 823) yuan in patients with laparoscopic operation and (168± 60) minutes,(157.2± 10.3) mL,(5.8± 1.7) days,(11.3 ± 3.5) days,(38 462± 1 961) yuan in patients with open operation.Two patients with ESD had subcutaneous emphysema and didn't receive special treatment,and then emphysema disappeared after 2 days.No complication was detected in patients with laparoscopic or open operations.(2) Postoperative pathological examination:tumor diameter in patients with ESD,laparoscopic operation and open operation was respectively (2.6± 1.6)cm,(6.1 ±2.2)cm and (6.4±2.3) cm.The cases with positive CD117,discovered on GIST-1 (DOG1),CD34 and smooth muscle actin (SMA) were 106,105,86,17 with ESD and 89,87,59,11 with laparoscopic operation and 46,47,30,8 with open operation,respectively.The extremely low risk,low risk,medium risk and high risk were respectively detected in 67,42,3,0 patients with ESD and 16,36,23,18 patients with laparoscopic operation and 7,20,14,8 in patients with open operation.(3) Follow-up and survival situations:210 of 254 patients were followed up for 6.0-120.0 months,with an average time of 36.0 months,including 86 with ESD,82 with laparoscopic operation and 42 with open operation.During the follow-up,of patients with ESD,3 patients with medium risk respectively received imatinib therapy for 7.0 months,1.5 years and 2.0 years,and postoperative gastroscopy reexaminations every 6 months,without tumor recurrence;81 with extremely low risk and low risk received postoperative gastroscopy reexaminations every 6 months and didn't receive targeted therapy,without tumor recurrence;2 died of non-stromal tumor.The postoperative average survival time,1-,3-and 5-year survival rates were respectively 56.3 months,98.8％ (81/82),91.5％ (75/82),74.4％ (61/82) in patients with laparoscopic surgery and 52.4 months,97.6％ (41/42),85.7％ (36/42),81.0％ (34/42) in patients with open surgery.Conclusions According to patients' conditions,endoscopic resection,laparoscopic resection and open resection are safe and feasible in the treatment of GIST.Endoscopic resection of GIST should be selectively applied to patients with smaller diameter,with advantages of lower hospitalization expenses and better long-term prognosis.
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Objective To summarize the features of signs of digital subtraction angiography (DSA) of small intestinal stromal tumor (SIST) with different invasion risk degrees.Methods The clinical data of 15 patients with SIST who were admitted to the West China Hospital of Sichuan University from September 2008 to June 2010 were retrospectively analyzed.The signs of DSA of SIST with different invasion risk degrees were analyzed.Results The result of DSA showed that 1 patient with low-invasive SIST presented draining veins and clear edge with homogeneously stained tumor in arterial phase.Enlarged tumors vessels,sharp edges and uniform tumor staining were observed in 4 patients with low-invasive risks.Enlarged and disordered tumor vessels and irregular shape were observed in 4 patients with moderate-invasive risks,and 3 of them showed heterogeneity stained tumor.Obvious enlarged and disordered tumor vessels,unclear edge and uniform tumor staining were showed in 6 patients with high-invasive risks.Conclusions The higher invasive risks correlates with more irregular and disorder tumor vessels.The tumors with lower-invasive risks have more regular and trim blood vessels.
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Gastrointestinal stromal tumor (GIST) arises from gastrointestinal tract,omentum,mesentery or peritoneal surface.Of which,about 60％ arises from stomach.The principle of surgical treatment is removing the tumor as completely as possible.The indications of operation for metastatic and recurrent GIST are perforation,obstruction and hemorrhage.The majority of gastric stromal tumor can be removed with local or wedge excision.Proximal gastrectomy is a choice for GIST locating at the cardia since local resection may cause cardia stenosis.Distal gastrectomy is suitable for GIST locating at lesser curvature of gastric antrum.Total gastrectomy is not a common procedure for gastric stromal tumor.Combined spleen,tail of pancreas and transverse colon resection may necessary for R0 surgery.Local resection is the first choice for duodenal stromal tumor,pancreaticoduodenectomy can be performed in large medical center.Operative procedure must be carefully carried out for small intestinal stromal tumor to avoid tumor rupture.Combined resection is a right choice when tumor involved surrounding organs or structures.In principle,low anterior instead of abdominoperineal resection is the only reconmend procedure for rectal stromal tumor.
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Conventional morphological evaluation criteria cannot objectively reflect the histopathological changes of gastrointestinal stromal tumor (GIST) to targeted therapy,and therefore it is unable to adapt to the requirements of the development of personalized medicine.The emerging of Choi and subsequent joint criteria of computed tomography diagnosis provides new methods for the evaluation of the histopathological changes of GIST to targeted therapy.Positron emission tomography (PET)-standardized uptake value (SUV) and apparent diffusion coefficient (ADC) on diffusion-weighted magnetic resonance imaging (MRI) can reflect the histopathological changes of GIST to targeted therapy in the early stage through functional imaging,and provide new potential biomarkers for evaluating the efficacy.Standardized radiological examination and evaluation process are conducive to launch the personalized treatment of GIST.
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The combination of laparoscopy and gastroscopy makes up the defects of each of them when used alone, and further extends the application range of minimally invasive techniques. A 53-year-old patient with gastric stromal tumor was admitted to the Tenth People's Hospital of Tongji University on March 4, 2011. The result of gastroscopy showed that the tumor was at anterior wall of stomach with a size of 3.0 cm×3.5 cm. the result of CT scan preliminarily diagnosed the patient with gastric stromal tumor. Partial gastrectomy with laparoscopy combined with gastroscopy was applied to the patient on March 9, 2011. The operation time was 32 minutes and the blood loss was 10 ml. The duration of hospital stay was 4 days, and no postoperative complication occurred. Laparoscopy combined with gastroscopy for the treatment of gastric stromal tumor is feasible and safe with a favorable short-term outcome.