Gastric Gastrointestinal Tumors Research Articles

Clinical outcomes of endoscopic resection for gastrointestinal stromal tumor originating from the muscularis propria: A single-center experience.

407 Background: With the remarkable advance of endoscopic techniques, endoscopic submucosal dissection (ESD) has become an effective and safe treatment modality for various gastrointestinal tumors (GISTs). However, there is still a lack of evidence on endoscopic treatment of GISTs in the stomach. We aimed to investigate the efficacy and safety of ESD for gastric GISTs and to assess possible predictive factors for incomplete resection. Methods: Between October 2008 and July 2022, a total of 35 patients with gastric GIST underwent ESD at our hospital. Clinicopathologic characteristics of patients and GISTs, therapeutic outcomes, adverse events and follow-up outcomes were evaluated. Results: The overall rates of en bloc resection and complete resection were 77.1% (27/35), 68.6% (24/35), respectively. The median procedure time was 47.3 minutes (range, 15–131 minutes). The procedure-related bleeding and perforation rates were 2.9 % and 17.1%, respectively. In univariate analyses, EUS growth pattern (intraluminal growth, p = 0.027) was independently associated with complete resection. During the median follow-up period of 15.4 months (range, 5.7 – 129 months) in 35 patients except two patients who underwent surgery and one patient who failed to follow up, recurrence occurred in one patient with macroscopically incomplete resection. Conclusions: ESD is an effective, safe, and feasible treatment for gastric GISTs. The frequency of complete resection is increased in EUS with an intraluminal growth pattern. [Table: see text]

The value of multi-slice CT-based tumor predominant feeding artery sign in the localization diagnosis of exophytic tumors in the pancreaticogastric space

Objective To evaluate the value of multi-slice CT-based tumor predominant feeding artery sign in the localization diagnosis of exophytic tumors in the pancreaticogastric space. Methods CT images of 34 patients with pathologically proven exophytic tumors located in the pancreaticogastric space including 20 gastric gastrointestinal stromal tumors (GIST) and 14 pancreatic tumors,7 patients of neuroendocrine neoplasms (NEN) and 7 patients of solid pseudopapillary neoplasms (SPN) were retrospectively analyzed. Two radiologists identified the tumor feeding arteries of the tumors and made the localization diagnoses. The inter-observer agreement was evaluated by Kappa coefficient. Chi-square test or Fisher exact test was used to compare the visualization of tumor predominant feeding artery sign in the two groups. Results The tumor feeding arteries were identified in 19 of 20 gastric GISTs and 13 of 14 pancreatic tumors. The two observers had a good agreement on the origins of the tumor feeding arteries(Kappa coefficient: 0.681). There was statistically significant difference in the origins of the tumor feeding arteries between the two groups (χ2=23.86,P<0.01). The blood supplies of most GISTs originated from gastric arteries, while those of most pancreatic tumors originated from the pancreatic branch of splenic artery. The tumor predominant feeding artery sign was identified in 17 gastric GISTs (17/20, 85.0%) and 11 pancreatic tumors (11/14, 78.6%). There was no statistically significant difference in the positive rate of the sign between the two groups (P=1.000). For all tumors enrolled, the sensitivities, specificities, accuracies, positive predictive values, and negative predictive values of the sign for the localization diagnosis of gastric GISTs and pancreatic tumors were 85.0% (17/20), 92.9% (13/14), 88.2% (30/34), 94.4% (17/18), 81.3% (13/16) and 71.4% (10/14), 100.0% (20/20), 88.2% (30/34), 100.0% (10/10), 83.3% (20/24), respectively. Conclusion The tumor predominant feeding artery sign on multi-slice CT can assist in the localization diagnosis of gastric and pancreatic exophytic tumors in the pancreaticogastric space. Key words: Gastrointestinal stromal tumors; Pancreatic neoplasms; Tomography, X-ray computed

PRE-OPERATIVE GASTRIC GIST DOWNSIZING: THE IMPORTANCE OF NEOADJUVANT THERAPY.

ABSTRACTIntroduction:Gastric gastrointestinal tumors (GIST) are a rare and usually asymptomatic neoplasm that can present as abdominal mass in more advanced scenarios. Since surgical resection is the main aspect of the treatment, locally advanced tumors require multivisceral resection and, therefore, higher postoperative morbidity and mortality. Objective:To perform a review the literature on the topic, with emphasis on the neoadjuvant therapy. Methods:Literature review on the Medline database using the following descriptors: gastrointestinal stromal tumors, neoadjuvant therapy, imatinib mesylate and molecular targeted therapy. Results:Surgical resection remains the cornerstone for the treatment of GISTs; however, tyrosine kinase inhibitors have improved survival as an adjuvant therapy. More recently, neoadjuvant therapy have been described in the treatment of locally advanced tumors in order to avoid multivisceral resection. Conclusion:Despite surgical resection remains as the most important aspect of the treatment of GISTs, adjuvant and neoadjuvant therapy with tyrosine kinase inhibitors have shown to both improve survival and resectability, respectively.

Analysis of the clinical value of immunohistochemistry in the diagnosis of gastrointestinal stromal tumors

Objective To investigate the expression of immunophenotype in gastrointestinal stromal tumors and analyze its clinical value in the diagnosis and prognosis of gastrointestional stromal tumors. Methods Reviewed the clinical data of 323 patients with gastrointestinal stromal tumors in Fuzhou General Hospital of PLA from January 2004 to January 2014. Detected expressions of CD-117, DOG-1, CD-34, alpha-SMA, S-100. Desmin and Ki-67 by immunohistochemical S-P method, frequency statistics, independent sample t test and correlation analysis was carried out with SPSS 20. Results The positive rates of CD-117, DOG-1 and GIST in the group CD-34 were 97%, 95.6% and 86% respectively, the positive rates of alpha-SMA, S-100 and Desmin were 59.8%, 27.7% and 17% respectively, the positive expression of CD-117, CD-34, alpha ɑ-SMA and Desmind in intestinal gastrointestinal stromal tumors and gastric gastrointestinal stromal tumors were significantly different, among them (P<0.05), the positive rates of gastrointestinal stromal tumors and alpha-SMA in intestinal CD-117 were significantly higher than those in gastric gastrointestinal stromal tumors (3.37 vs 2.99, P=0.002; 1.59 vs 1.09 P=0.005). The positive expression of CD-34 and Desmin was significantly lower than that of gastric gastrointestinal stromal tumors (1.90 vs 3.02, P=0.000; 0.12 vs 0.50, P=0.001). The expression of CD-117 was significantly correlated with location and risk grade (P=0.000, 0.002). The expression of DOG-1 was significantly correlated with the risk grade, and the overall survival (P<0.05). The expression of CD-34 was significantly correlated with location, size, risk grade, status, and overall survival (P=0.000, 0.007, 0.016, 0.001). There was a significant correlation between the expression of alpha-SMA and location (P=0.036). There was a significant correlation between the expression of S-100 and the overall survival (P=0.036). The expression of Desmin was significantly correlated with the age and location of the first visit (P=0.001). Conclusion In the diagnosis of gastrointestinal stromal tumors, CD-117, DOG 1 and CD-34 combined alpha-SMA and Desmin have good complementation, it is also helpful to judge the location of the intestine and stomach of gastrointestinal stromal tumors, if necessary, it can also be detected by gene mutation, with reference to the level of mitotic figures, which can reduce the misdiagnosis rate and increase the detection rate. Key words: Immunohistochemistry; Prognosis; Neoplasms; Gastrointestinal stromal tumors

Evaluating treatment effects of gastric gastrointestinal stromal tumors between open and endoscopic ultrasonography guided endoscopy resection approaches: revealing minimally invasive, fast recovering and economical surgery for patients

Background: This study aims to compare the clinical outcomes of endoscopic and open approaches in patients with gastrointestinal stromal tumor (GIST). GIST is a relatively rare type of neoplasms. It represents 1% of gastrointestinal tumors (GITs) and 20–30% of all malignancies. Most of the GISTs develop in the area of stomach. Methods: In this retrospective study, 77 patients who underwent surgery for GIST tumors within length of 1.5–4 cm were divided into two groups according to type of surgical approach: open surgery (OS group, n=36) and endoscopy resection (ER group, n=41). The clinical outcomes were compared between the two groups. Results: OS group contains 36 in total with 58.33% male and 41.67% female. ER group contains 41 in total with 43.9% male and 56.1% female. In comparison to conventional OS, patients treated with endoscopic ultrasonography (EUS) guided ER showed significantly less time in surgery procedure, less operative blood loss, less complication rates, less duration for postoperative fasting and postoperative hospitalization, indicating a quicker recovery and better clinical outcome. Furthermore, treatment group with ER displayed reduced expense of hospitalization due to lower procedure expense and shorter hospital stay with rare tumor recurrence. Here, we also included an example case report of successful treatment of GIST with ER. Conclusions: Endoscopic tumor resection is an effective method to remove non-high risk GISTs in patients comparing to OS, and may be beneficial to patients economically.

Adult gastric duplication: an unknown condition within the spectrum of gastric submucosal lesions

Gastric duplication is an uncommon condition in adults representing only 4-8% of all gastrointestinal duplications. It develops as a cystic growth within the thick gastric wall that is surrounded by a layer of smooth muscle and lined with gastric mucosa. It is usually asymptomatic but may present with nonspecific abdominal symptoms as well as cyst-related complications such as gastrointestinal (GI) bleeding, ulceration and even pancreatitis. They are difficult to distinguish from other gastric submucosal lesions and may also mimic a gastrointestinal tumor (GIST) or mucinous cyst of the pancreas. Endoscopic ultrasound (EUS) is the most widely used diagnostic procedure and histology provides a definitive diagnosis. We report the case of a 36-year-old female patient with a history of a "contained" perforated gastric ulcer that was managed conservatively. The patient was diagnosed with a gastric GIST which prompted a laparoscopic subtotal gastrectomy and Roux-en-Y reconstruction with a good postoperative outcome. The definitive histological diagnosis was gastric duplication. Thus, the previous diagnosis of a "contained" perforated gastric ulcer was in fact a complication of the gastric duplication itself.

Current status of surgical treatment of gastric gastrointestinal tumors: a national multi-center retrospective study

To retrospectively analyze the clinicopathology of patients with gastric gastrointestinal stromal tumor(gGIST) who underwent radical excision within 18 years in 10 domestic medical centers in order to understand the status of domestic surgical treatment of gGIST. Clinicopathological data of gGIST patients undergoing radical excision in 10 medical centers from January 1998 to January 2016 were collected, and their operational conditions, postoperative adjuvant therapy, gene detection and survival were analyzed retrospectively. A total of 1 846 cases were recruited in this study, including 246 cases from Guangdong General Hospital, 331 cases from Sun Yat-sen University Cancer Center, 374 cases from Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, 342 cases from Nanfang Hospital of Southern Medical University, 265 cases from Fujian Medical University Union Hospital, 148 cases from Fudan University Shanghai Cancer Center, 49 cases from West China Hospital of Sichuan University, 43 cases from Peking University Cancer Hospital and Institute, 28 cases from the 81st Hospital of Pepole's Liberation Army(PLA), 20 cases from Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute. There were 918 male (49.7%) and 928 female patients (50.3%) with median onset age of 59(18 to 95) years old. Fundus(735 cases, 39.8%) and body (781 cases, 42.3%) of stomach were the common sites of lesions. The average size of tumor was (5.3±4.6) cm. There were 1 421 cases with mitotic count ≤5(77.0%). According to the operation procedure, 924 cases (50.1%) underwent laparoscopic surgery, 759 cases (41.1%) laparotomy, 120 cases (6.5%) endoscopic surgery, and 20 cases (1.1%) laparoscopic combined with endoscopic surgery, 6 cases (0.3%) laparoscopic excision surgery through gastric wall and cavity, and 17 cases (0.9%) laparoscopy and then were transferred to laparotomy. Wedge excision were performed in 1 308 cases (70.9%), proximal gastric excision in 226 cases(12.2%), distal gastric excision in 92 cases (5.0%), total gastrectomy in 94 cases (5.1%), and local gastrectomy in 126 cases(6.8%). Multi-visceral excision was performed in 138 cases, and the splenectomy was performed in 83 cases(60.1%)with the highest ratio. According to modified NIH classification, 399 cases(21.6%) were extreme low risk, 580 cases(31.4%) were low risk, 424 cases(23.0%) were moderate risk, 443 cases (24.0%) were high risk. A total of 461 cases received postoperative imatinib adjuvant therapy, accounting for 53.2%(461/867) of patients with moderate and high risk. Among 1 846 cases, 1 402 cases (75.9%) had complete follow-up data and the median follow-up time was 33.6 (0.1 to 158) months. The 5-year survival rates of extreme low risk, low risk, moderate risk and high risk were 100%, 98.5%, 92.5%, and 79.2% with significant difference(P=0.000). Gastric GIST occurs mostly in fundus and body of stomach in China. Wedge excision is the main operational procedure and laparoscopic operation is over 50%. General prognosis of gastric GIST is quite good.

Efficacy analysis of laparoscopic curve resection for gastric gastrointestinal stromal tumor

To evaluate the feasibility and safety of curved cutter stapler in laparoscopic curve resection for gastric gastrointestinal stromal tumor(GIST). A retrospective clinical study was carried out with the clinical data of 19 cases of gastric GIST, who received laparoscopic curve resection with the curved cutter stapler during the period between January 2015 and December 2015 in Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University. Curved cutter stapler was used intraoperatively to run curve resection for stomach, at least 0.5 cm away from the tumor outer margin. If the curved cutter stapler could not completely cut off the gastric wall at first time, the linear cutter stapler would be used secondly to cut off the remaining gastric wall. All the cases were successfully performed under laparoscopy, without conversion to open surgery and the occurrence of severe complications. Fourteen(73.7%) patients received complete transection by the first curved cutter stapler, the other 5(26.3%) cases accepted complete transection by the second linear cutter stapler. The operative time ranged from 50 to 100(71.8±12.7) minutes, the blood loss ranged from 20 to 50 (33.6±7.4) ml, the postoperative exhaust time ranged from 1 to 4 (2.4±0.9) days, the postoperative hospital stay ranged from 5 to 9(6.8±1.1) days. There was no patient suffered from incision infection, delayed gastric emptying, anastomotic leakage and anastomotic bleeding. The postoperative pathological examination confirmed that all the cases were GIST. The tumor length ranged from 1.5 to 5.5(2.9±1.1) cm, the resection margin ranged from 0.5 to 2.0(1.2±0.4) cm and all the patients had negative resection margins. Of the 19 cases, 8(42.1%) were classified as very low risk, 5(26.3%) as low risk, 5(26.3%) as moderate risk and 1(5.3%) as high risk according to the National Institute of Health classification. Six patients with moderate and high risk were treated with imatinib. In the follow-up time of 5 to 16 months(mean 10 months) after operation, no distant metastasis and local recurrence occurred in all the cases. The application of curved cutter stapler in laparoscopic curve resection for GIST is safe and feasible with good short-term efficacy.

Evaluation of clinical treatment of primary small gastric gastrointestinal stromal tumors: a retrospective single-center study

Objective To investigate the clinicopathologic features of primary small gastrointestinal stromal tumors (GISTs) and to evaluate the efficacy and safety of endoscopic resection based on ESD. Methods A retrospective analysis was performed in patients with pathologically proved small GISTs who underwent endoscopic resection(n=107) or surgery including open laparotomy or laparoscopic surgery(n=36) at Drum Tower Hospital from January 2012 to June 2015.The clinicopathologic features, treatment, adverse events, and prognosis were evaluated. Results 1) A total of 143 patients were included in the study, 79.7% of whom with small GISTs were asymptomatic. Approximately 53.8% of GISTs occurred in the fundus of stomach. The median tumor size was 1.3 cm. Preoperative endoscopic ultrasonography (EUS) revealed they were all classified as very low risk. Histological examinations showed that 112 (78.3%) patients were classified as very low risk, 24 (16.8%) as low risk, 4 (2.8%) as moderate risk and 3 (2.1%) as high risk. Subgroup analysis suggested that the size of GISTs classified in moderate or high risk ranged from 1 to 2 cm. 2) The complete resection rate was close, 90.7% in endoscopy group and 100% in surgery group, respectively. Hospital stay was shorter in endoscopy group than that in surgery group (5 d VS 8 d, P<0.001). And the incidence of postoperative infection was lower in endoscopic group than in surgical group (0.9% VS 19.4%). No recurrence or metastasis was detected, with the median follow-up period of 24 months. Conclusion In most of the cases, small gastric gastrointestinal stromal tumors occur in the fundus of stomach. Most patients with GISTs are asymptomatic, most of which are classified as very low risk or low risk. Preoperative EUS has a limited value in evaluating invasive risk of small gastric GISTs. Endoscopic therapy based on ESD is feasible and safe in managing small gastric GISTs if complete resection can be assured. Key words: Small gastric stromal tumor; Endoscopy; Ultrasonography; Endoscopic submucosal dissection; Retrospective studies

Suggested cutoff tumor size for small gastric gastrointestinal stromal tumors

Background: To investigate if there is an appropriate cutoff tumor size for small gastric gastrointestinal stromal tumors (GISTs) or not, and whether the cutoff size could be used to predict the tumor progression for small gastric GISTs during follow-up. Methods: From May 2010 to March 2014, 97 patients were enrolled in the present study, including 90 small gastric GIST patients underwent resection, and 7 endoscopic ultrasound (EUS) suspected small gastric GIST patients. The cutoff tumor size of small gastric GISTs was calculated based on mitotic index using receiver operating characteristic (ROC) analysis. Results: Of the 90 patients, mitotic index of 18 small gastric GISTs (20%) exceeded 5/50 HPF. Using ROC analysis, we found that 1.4 cm may be considered as an appropriate cutoff tumor size. The ratio of CT enhancement, tumor ulceration, mitotic index exceeds 5/50 HPF and low risk category was significantly higher in tumors between 1.4 and 2.0 cm than that of tumors less than 1.4 cm (all P<0.05). EUS suspected small gastric GISTs between 1.4 and 2.0 cm showed significant tumor progression during follow-up (median 11.8 months, range from 10.1 to 24.5 months). Conclusions: The 1.4-cm may be considered as a more reasonable cutoff tumor size for small gastric GISTs. We recommended that all small gastric GISTs should be resected once diagnosed, at least for tumors between 1.4 and 2.0 cm.

Comparative study of laparoscopic and open surgery for gastric gastrointestinal stromal tumors

To investigate the feasibility and short-term efficacy of laparoscopic resection of primary localized gastric gastrointestinal stromal tumors (GIST) by comparing with open surgery. Clinicopathological data of 167 gastric GIST patients undergoing operation in Zhongshan Hospital from June 2008 to December 2013 were retrospectively analyzed, among whom 55 received laparoscopic surgery and 112 underwent open surgery for primary local gastric GIST. Efficacy of different size and different location of GIST was compared between laparoscopic and open groups. There was no conversion to open surgery in laparoscopy group. Compared with open surgery, laparoscopic resection for gastric GIST smaller than 5 cm or located at anterior wall, greater curvature, lesser curvature, was associated with similar operation time(P>0.05), but less blood loss, shorter post-hospital stay or flatus time(all P<0.05). The operative outcomes were similar between laparoscopic and open resection for gastric GIST bigger than or equal to 5 cm or located at posterior wall(all P>0.05), except the longer operation time in laparoscopy group(P<0.05). The incidence of postoperative complication did not differ between two groups. Laparoscopic group had 2 patients with gastroparesis and open group had 2 gastroparesis, 2 pulmonary infection, and 1 poor wound healing(all P>0.05), which all recovered after conservative treatment. During 7 to 84 months(median 35) of follow-up, no recurrence or hepatic metastasis was found in laparoscopy group, and 3 hepatic metastases in open group. There was no significant difference of recurrence-free survival between two groups(P>0.05). Laparoscopic resection for gastric GIST is safe and effective in selected patients, especially for those with tumors smaller than 5 cm, or located at anterior wall, greater curvature, lesser curvature, whose short-term outcomes are better than open resection.

Evaluation of preoperative endoscopic ultrasonography for diagnosis and invasive risk assessment of gastric gastrointestinal stromal tumors: a single-center retrospective study

Objective To evaluate preoperative endoscopic ultrasonography(EUS)for diagnosis and invasive risk assessment of gastric gastrointestinal stromal tumors(GISTs). Methods A total of 248 patients diagnosed as having gastric GISTs based on preoperative EUS and with established pathologic results at our institution were recruited to the study. The coincidence rates for gastric GISTs between preoperative EUS and pathologic results were calculated. Univariate and multivariate analyses were used to explore the possible predictors for the coincidence rates. EUS features were compared according to histological risk classification of very low/low risk malignant potential or intermediate/high risk malignant potential. Results The overall coincidence rate for gastric GISTs between EUS and pathologic results was 67.7%(168/248). Univariate analysis showed that tumor diameter, mucosal bridge, heterogeneity, and calcification were significantly correlated with the coincidence rate for gastric GISTs between preoperative EUS and pathologic results. Multivariate analysis indicated that heterogeneity (OR=2.53, 95%CI: 1.23-5.18, P=0.011) and calcification(OR=2.25, 95%CI: 1.34-6.56, P=0.045) were the independent factors for the coincidence rate. A total of 168 patients were divided into four groups according to histological risk: very low risk(n=63), low risk(n=62), intermediate risk(n=26), and high risk(n=17). Gastric GISTs with heterogeneity, mucosal ulceration, and calcification on EUS suggested higher risk GISTs. Multivariate analysis indicated that only tumor diameter(P<0.000 1)could predict malignant potential of gastric GISTs. Conclusion Preoperative EUS plays an role in diagnosing and evaluating of invasive risk for gastric GISTs, which might aid the clinical management of gastric GISTs. Key words: Risk assessment; Mesenchymoma; Endosonography

Endoscopic purse-string suture for the gastric wall defect after full-thickness resection

To evaluate the efficacy of endoscopic purse-string suture (EPSS) with metallic clips and endoloop for the gastric wall defect after postoperative perforation. Clinical data of 25 patients with gastric tumors(1 of gastric adenocarcinoma, 24 of gastric gastrointestinal stromal tumor, GIST) undergoing EPSS in Jiangsu Province People's Hospital and The Second Affiliated Hospital of Nanjing Medical University from January 2013 to May 2014 were retrospectively analyzed. During the procedure, EPSS was performed in 8 cases with perforation after endoscopic submucosal dissection(ESD), and in 17 cases with active perforation after endoscopic full-thickness resection. Twenty-five patients underwent EPSS successfully. The procedure time was 35.0-75.0(49.8±10.1) min. No severe operational and postoperative complications occurred. Tumor resection margin were all negative. Time to withdraw gastrointestinal decompression drainage tube was 1-3(1.3±0.8) d. Postoperative hospital stay was 2-10(4.8±2.1) d and total cost was 10-31(19±0.5) thousand Yuan. One month after the procedure, all the patients received follow-up with no complaint of discomfort, and endoscopy confirmed that all the lesions healed. EPSS with metallic clips and endoloop is effective and safe to close the gastric wall defect after full-thickness resection.

MANEJO QUIRÚRGICO SIMULTÁNEO DE UNA PACIENTE CON CÁNCER DE PÁNCREAS DISTAL, TUMORES DEL ESTROMA GASTROINTESTINAL (GIST) GÁSTRICOS Y HEMANGIOMA HEPÁTICO

Simultaneous surgical management of a patient with distal pancreatic cancer, gastric gastrointestinal tumors (GIST) and hepatic hemangioma Introduction: The occurrence of gastric Gastrointestinal Stromal Tumors (GIST) associated to pancrea- tic adenocarcinoma has been reported in 0.2% pancreatic cancers. There are no published reports on distal pancreatic adenocarcinoma associated to gastric antral GIST and the surgical management of this clinical condition. Case report: Herein, we discuss a 75 years-old female patient who was admitted to our institution with upper digestive hemorrhage. The endoscopy showed large, superficial erosions over the cardia and on the posterior wall of the antrum a rounded sub-mucosal non-eroded lesion suspected of gastric GIST. An ab- dominal computed tomography scan found a hepatic hemangioma on the left hepatic lobe. In the pancreatic distal body and tail a solid exophytic lesion was identified. In the gastric antrum a rounded submucosal tumor in close contact with the pancreatic lesion was found. The patient was subjected to distal pancreatectomy, splenectomy, and distal gastrectomy. The biopsy identified a well-differentiated ductal adenocarcinoma locali - zed in the pancreatic tail and the proximal part of the body, resected with negative margins. The gastric tumor was positive for CD117, CD34, and DOG-1; it had a positive Ki67 in less than 2%, and 2 or less mitoses per 50 high-power fields. Conclusion. This uncommon case illustrates the occurrence of synchronous tumors of different cellular origins incidentally diagnosed and their simultaneous surgical treatment. The individual incidence of these tumors is low and if associated they probably will continue to be found incidentally.

Efficacy analysis of endoscopic submucosal excavation for gastric gastrointestinal stromal tumors

To assess the efficacy and safety of endoscopic submucosal excavation(ESE) for gastric gastrointestinal stromal tumors(GISTs). Clinical data of 86 gastric GISTs patients undergoing ESE in our department from January 2007 to January 2013 were analyzed retrospectively. The whole tumor biopsy was used to determine the risk stratification. Complication of ESE was recorded and recurrence was investigated during regular follow-up. Tumors of all 86 cases were resected completely without residue proved by postoperative pathology. According to NIH risk stratification, 12 cases were very low risk, 30 low risk, 25 moderate risk, and 19 high risk. Tumor size, tumor depth, and tumor surface bleeding or edema were associated with the risk stratification of the GISTs(all P<0.05). Bleeding rate of ESE was 5.8%(5/86), including severe intraoperative bleeding in 1 case, postoperative delayed bleeding in 4 cases. The maximal tumor diameter was <2 cm in 1 case and >2 cm in 4 cases. The tumor were grade as moderate risk in 3 cases and high risk in 2 cases. The perforation rate was 10.5%(9/86), including tumors with a maximal diameter of <2 cm in 4 cases and >2 cm in 5 cases. The tumors were grade as moderate risk in 5 cases and high risk in 4 cases. Recurrence rate was 5.8%(5/86), including tumors with a maximal diameter <2 cm in 2 case and >2 cm in 3 cases. The tumors were grade as moderate risk in 4 cases and high risk in 1 cases. ESE is safe and effective for the treatment of gastric GISTs. The operative complication and postoperative recurrence may be associated with the tumor risk stratification.

Efficacy analysis of laparoscopic surgery for primary local gastric and intestinal gastrointestinal stromal tumors

To investigate the feasibility and short-term efficacy of laparoscopic resection of primary local gastric and intestinal gastrointestinal stromal tumors(GIST). Clinicopathological data of 26 patients with GIST, 20 located at the stomach and 6 at the intestine, undergoing laparoscopic complete resection from October 2010 to April 2013 were retrospectively analyzed. Hand-assisted laparoscopic surgery was performed in 3 patients with gastric GIST, while the other 23 underwent regular laparoscopic surgery. All the procedures were performed successfully without conversion to open operation. According to tumor location and growth types, gastric local resection was performed in 18 cases, distal gastrectomy in 2 cases and intestinal segmental resection in all 6 cases of intestinal GIST. The mean diameter of tumor was (4.5±1.6) cm. The mean operational time was(96.2±28.2) min, with a mean blood loss of (49.6±38.6) ml. Postoperative bowel function recovery time was (2.3±0.7) d and the length of postoperative hospital stay was (6.8±1.9) d. Bleeding from gastrointestinal tract developed in 1 patient after resection of intestinal GIST. Postoperative pathology indicated very low risk of GIST in 1(3.8%), low risk in 13(50.0%), intermediate in 9(34.6%) and high risk in 3(11.5%) patients, respectively. After a follow-up ranging form 3 to 32 months, no recurrence or death was found. Laparoscopic surgery of primary local GISTs from stomach or intestine is safe and feasible in selected patients, with less invasiveness, rapid recovery, and favorable short-term outcomes.

Synchronous Occurrence of Early Gastric Cancer and a Gastrointestinal Stromal Tumor at the Same Site: A Case Report

A 70-year-old male was admitted to our institution with a complaint of vomiting in mid-September 2011. Upper gastroendoscopy revealed an approximately 20 mm submucosal tumor in the anterior wall of the lesser curvature at the lower gastric body that was overlain by 15 mm type 0-I conglomerate lesion. Distal gastrectomy and reconstruction using Billroth I was performed in mid-November 2011. Gross specimen revealed an 18×18×10 mm elastic, hard submucosal tumor in the lesser curvature at the lower body, which was overlain by a 14×14×8 mm type 0-I conglomerate lesion. Hematoxylin and eosin staining of the submucosal tumor revealed spindle cells, positive for c-kit and CD34, but negative for desmin and S-100 proteins after immunochemical analysis; thus, an uncommitted type of gastrointestinal tumor (GIST) was diagnosed. Pathological analysis of the type 0-I lesion revealed a well differentiated tubular adenocarcinoma. There was no continuity between gastric cancer and GIST. His postoperative course was uneventful and the patient was discharged ambulatory 25 days after admission. This case represents a rare case of synchronous occurrence of early gastric cancer and GIST at the same site.

Clinical presentations of gastric small gastrointestinal stromal tumors mimics functional dyspepsia symptoms.

To explore whether clinical presentations of gastric small gastrointestinal tumors (GISTs) mimics gastrointestinal dyspepsia symptoms. The endosonographic data of 167 patients who underwent endoscopic submucosal dissection at the Tianjin Medical University General Hospital, China between 2009 and 2011 were analyzed. GISTs and leiomyomas had a similar intragastric distribution and similar locations within the gastric wall. Therefore, patients with GISTs were chosen as the study group and those with leiomyomas were chosen as the control group. Dyspepsia symptom questionnaires were used to investigate and compare the gastrointestinal symptoms of patients with GISTs and those with gastric leiomyomas before and after endoscopic submucosal dissection (ESD). The questionnaires evaluated symptoms such as epigastric pain, heartburn, regurgitation, epigastric discomfort, nausea and vomiting, abdominal bloating, and eructation. Symptoms were assessed using a four-point scoring scale. GISTs were the most common gastric submucosal lesion (67 cases, 40.12%), followed by leiomyomas (38 cases, 22.75%). Both groups were similar in terms of gender distribution (P = 0.49), intragastric location (P = 0.525), and originating layer within the gastric wall (P = 0.449), but leiomyomas were more commonly found in the proximal fundus (P < 0.05). Overall, 94.2% of the patients with small GISTs and 93.5% of those with gastric leiomyomas experienced some dyspepsia; however, total symptom scores were significantly lower in the GIST group than in the leiomyoma group (1.34 ± 1.27 vs 2.20 ± 1.70, P < 0.05). Each component of the symptom score demonstrated a statistically significant improvement in the GIST patients after ESD (P < 0.05), including epigastric pain (0.80 ± 0.90 vs 0.13 ± 0.46), heartburn (0.63 ± 1.08 vs 0.13 ± 0.41), regurgitation (0.55 ± 0.87 vs 0.22 ± 0.57), epigastric discomfort (0.70 ± 0.98 vs 0.32 ± 0.47), nausea and vomiting (0.27 ± 0.62 vs 0.05 ± 0.21), abdominal bloating (0.70 ± 0.90 vs 0.27 ± 0.49), and eructation (0.36 ± 0.61 vs 0.21 ± 0.46). For leiomyoma patients, symptoms such as heartburn, nausea, vomiting, and eructation improved after treatment; however, these improvements were not statistically significant (P > 0.05). Thus, the pathophysiology of dyspepsia symptoms may be different between the two groups. Symptoms of gastric small GISTs may mimic those of functional dyspepsia. An alternative diagnosis should be considered in patients with functional dyspepsia and treatment failure.

Laparoscopic surgery of gastric gastrointestinal stromal tumor

Gastric gastrointestinal stromal tumor(GIST) is the most common mesenchymal neoplasms of the gastro-intestinal tract.For its unique biological behavior with KIT gene expression and the particular clinical characteristics with the recurrent nature, surgery and molecular targeted therapy is the main treatment of gastric GIST. Laparoscopic technology has been used in the surgical treatment of gastric GIST and is the future trend. In this article, we shed some light on the standardize surgical procedures of radical laparoscopic gastrectomy, obeying the surgical principles, accurate intraoperative localization, and surgery combined with targeted therapy.

Clinical analysis of laparoscopic and endoscopic cooperative surgery in the treatment of gastric gastrointestinal stromal tumor: report of 46 cases

To evaluate the feasibility and safety of laparoscopic and endoscopic cooperative surgery for treating gastric gastrointestinal stromal tumors(GIST). Retrospective analysis was performed on the clinical data of 46 patients with gastric GIST undergoing laparoscopic and endoscopic cooperative surgery between June 2009 and June 2011 at the Renji Hospital of Shanghai Jiaotong University School of Medicine. There were 27 males and 19 females with the mean age of 58.5 years. Thirty-three patients received endoscopy-assisted wedge resection, and 13 cases received laparoscopy-assisted endoscopic resection. All the operations were successful. The mean operative time was (85.5±29.3) min, the mean blood loss was (31.4±12.2) ml, the mean post-operative gastrointestinal functional recovery time was (31.6±14.9) h, and the mean post-operative hospital stay was (5.1±2.9) d. No post-operative complication occurred. NIH risk assessment showed that 34 cases were very low risk and 12 low risk. No recurrence or metastasis was found during the follow-up ranging from 2 to 26 months(median, 12.6 months). Laparoscopic and endoscopic cooperative surgery for gastric GIST is both feasible and safe with minimal invasiveness, fast recovery and satisfactory short-term outcomes.