GIST: a clinical dilemma.

The authors report a clinical case of malignant gastric and duodenojejunal GIST, in which the only surgical treatment seems to be definitive. In a 69-year-old female, a surgical resection of the gastric and duodenojejunal tumor was performed. Histological analysis showed two spindle cells stromal tumors with mitotic rate >20/10 HPF and its uncommitted origin was demonstrated. Despite the high malignancy degree, the patient refused chemotherapy treatment and there were no local recurrence nor metastasis at a follow-up of 8 years. For this reason and because of the uncertain behavior of histologically benign GIST, the authors propose a lifelong follow-up of all patients managed with potentially curative surgical resection.

One-stage treatment in emergency setting for obstructing colorectal cancer.

The aim of this study was to evaluate the indications for one-stage treatment of obstructing colorectal cancer. From January 1998 to December 2003, 19 patients were operated on at our department for obstructing colorectal cancer. Thirteen patients underwent one-stage operation with immediate anastomosis without diversion, while 6 patients were managed palliatively. We performed resection and anastomosis following intraoperative irrigation in obstructing sigmoid cancer without colonic wall lesions, while subtotal colectomy was carried out in case of massively distended colon with ischemic lesions. Colostomy was indicated in 6 high-risk patients with unresectable lesions. In case of obstructing left colorectal cancer, an experienced surgeon can perform one-stage resection and anastomosis on good general status patients, conversely defunctioning colostomy may be ideal for surgeons with little experience in colorectal surgery and in very poor prognosis patients.