Resection of esophageal gastrointestinal stromal tumors.

Abstract

e20503 Background: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of gastrointestinal tract. GISTs account for 0,1% to 0,3% of all tumors in the gastrointestinal tract. Two thirds of these tumors arise from the stomach, 25% arise from the small intestine and less than 5% arise from esophagus. Use of tyrosine kinase inhibitors has revolutionized therapy for GISTs but complete resection remains the treatment of choice. Methods: We report our experience (from 2005 to 2011) with five patients who underwent resection of esophageal GIST. Reviewed consensus management guidelines and performed a literature review for reported cases. Results: All five patients underwent surgery intervention at our institute. Four patients had no metastasis and they underwent tumor enucleation. Due to submucosal location only one of them was diagnosed with GIST by endoscopic biopsy before surgery. One patient had a giant liver metastasis invading totally all segments of right lobe of liver. He underwent transhiatal extirpation simultaneously combined with extended right-sided hemihepatectomy. That patient suffered from total dysphagia, 15 kg weight loss, gastrointestinal bleeding and a big lump in his right hypochondrium. After laparotomy we diagnosed big metastatic nodule invading the whole right lobe of liver 25 cm in diameter. After diaphragmotomy we diagnosed tumor of the lower third of esophagus. Consequently, we performed extended right-sided hemihepatectomy and transhiatal esophagus extirpation. Two months later esophageal plastics by means of ileocaecal segment of colon was performed. The pathological diagnosis was confirmed in all five cases by microscopic examination (KIT+; CD17+, mitotic rate). In adjuvant regime imatinib (400 mg/body/day) was administered for a year for all five patients. The patients are alive now, they were followed up every six months with CT for two years. Fortunately, no new tumors were observed during this period of time. Conclusions: Esophagectomy is the treatment of choice for esophageal GISTs but requires attention to operative details that emphasize complete en block excision of surrounding tissue and metastatic nodules.