Site Of Gastrointestinal Stromal Tumor Research Articles

Application of radiomics in predicting the preoperative risk stratification of gastric stromal tumors.

PURPOSE The stomach is the most common site of gastrointestinal stromal tumors (GISTs). In this study, clinical model, radiomics models, and nomogram were constructed to compare and assess the clinical value of each model in predicting the preoperative risk stratification of gastric stromal tumors (GSTs). METHODS In total, 180 patients with GSTs confirmed postoperatively pathologically were included. 70% was randomly selected from each category as the training group (n = 126), and the remaining 30% was stratified as the testing group (n = 54). The image features and texture characteristics of each patient were analyzed, and predictive model were constructed. The image features and the rad-score of the optimal radiomics model were used to establish the nomogram. The clinical application value of these models was assessed by the receiver operating characteristic (ROC) curve and decision curve analysis (DCA). The calibration of each model was evaluated by the calibration curve. RESULTS The Area Under the Curve (AUC) value of the nomogram was 0.930 (95% confidence interval [CI]: 0.886- 0.973) in the training group and 0.931 (95% CI: 0.869-0.993) in the testing group. The AUC values of the training group and the testing group calculated by the radiomics model were 0.874 (95% CI: 0.814-0.935) and 0.863 (95% CI: 0.76 5-0.960), respectively; the AUC values calculated by the clinical model were 0.871 (95% CI: 0.811-0.931) and 0.854 (95% CI: 0.76 0-0.947). CONCLUSION The proposed nomogram can accurately predict the malignant potential of GSTs and can be used as repeatable imaging markers for decision support to predict the risk stratification of GSTs before surgery noninvasively and effectively.

Cystic Esophageal Gastrointestinal Stromal Tumor (GIST): A Rare Presentation

astrointestinal stromal tumors (GIST) are solid tumors of the gastrointestinal tract. The stomach is the most common site while the esophagus is the least common site for gastrointestinal stromal tumors. The cystic Gastrointestinal stromal tumor has never been reported in the past. On CT scan of a young male patient, we reported an exophytic cystic structure of 2.5 x 2.2 cm along the esophagus as an esophageal duplication cyst then he underwent an image-guided biopsy that finally turned out to be a Gastrointestinal stromal tumor on histopathology. He underwent surgical resection; he is now symptomsfree and on 6 monthly CT scan follow-ups.

GIST in Third Part of Duodenum Causing Partial Obstruction – Laparoscopic Management

Background: Gastrointestinal Stromal Tumor (GIST) arises from the interstitial cells of Cajal. Stomach is the most common site of GIST. The usual presentations of GIST are gastrointestinal bleeding and abdominal pain. GISTs in the duodenum are uncommon. Duodenal obstruction due to GIST is even more uncommon. Duodenal GISTs are usually detected on endoscopy, however they can be missed on routine endoscopy if they are located in the third part of duodenum. Computed Tomography (CT) of abdomen is useful in determining the exact size, location and extent of tumor. In the absence of metastases, surgical excision is the mainstay of treatment. Case Presentation: We present a case of a duodenal GIST in the 3rd part of duodenum, causing partial obstruction to the duodenal lumen and causing recurrent abdominal pain and vomiting. Although technically challenging, we successfully excised this lesion laparoscopically. Furthermore, as it was a pedunculated tumor arising from the posterior wall of the duodenum, we performed a novel technique of laparoscopic duodenotomy and stapling of pedunculated tumor at the base and primary closure, rather than the conventional technique of wedge or segmental resection. Conclusion: Third part of the duodenum is a difficult location to access surgically and excision of tumors in this location is usually performed by the open method because of the technical difficulties of laparoscopic surgery in this location. However, with adequate expertise and advanced laparoscopic skills, laparoscopic excision of tumors in the third part of duodenum can be accomplished with good post-operative outcomes.

Different Medical Features and Strategies of Large Rectal Gastrointestinal Stromal Tumor: A Multi-Central Pooling Analysis.

PurposeThe rectum is a rare site for gastrointestinal stromal tumors (GISTs). Tumors in this critical anatomical site are prone to develop local recurrence, and this occurs at a high level even in low-risk tumors. Previous studies found that high-risk was the most common category in rectal gastrointestinal stromal tumors (RGISTs), and size was the most important factor affecting the long-term prognosis. We aimed to find out the most influential factor on clinical outcomes, and describe demographics, oncological differences, and surgical procedures in patients with poor prognosis.Patients and MethodsData on consecutive patients with RGIST, who were diagnosed at Peking University People’s Hospital, Shandong Province Hospital, and The First Affiliated Hospital of Shandong First Medical University from 2010 to 2020, were retrospectively evaluated. Further, a literature search was conducted by retrieving data from PubMed, EMBASE, and the Cochrane Library databases from inception up to March 20, 2020.ResultsIn all, 50 patients were diagnosed with RGIST at three medical centers, and 86 published records were finally included in the literature review. Combined analysis of the whole individual patient data showed that 5.5 cm was deemed an appropriate cut-off value for L-RGIST, and that patients usually showed a male predominance (67.59%), younger age at onset (56.61 years), higher operative difficulty, and poorer prognosis.ConclusionSeparation of patients with large RGIST from general patients may contribute to the recognition of the oncological characteristics and clinical management of this rare type of tumor.

Oncogene mutational analysis in imatinib naive population of gastrointestinal stromal tumor patients

There are very scanty reports on gastro-intestinal stromal tumors (GISTs), a very common tumor of mesenchymal cells in GIT track primary resistance to imatinib. This comprehensive study identifies the prevalence, clinical presentation and GIST genotype association in the imatinib naí¯ve population. Prospectively a record of anthropometric, baseline demographic data and clinical details for the patients diagnosed with GIST were scrutinized. Pathological information included the presence or absence of necrosis, tumor size, mitotic counts, immune-histochemical staining for CD 34, CD 117 and DOG1 was performed using biopsy sample. Selected exon genes of KIT, PDGFRA and BRAF were amplified and subjected to mutation analysis by direct sequencing. Appropriate statistical analyses were performed. The male/female ratio was 1.8:1 among 54 patients with GIST. The mean GIST size was comparatively bigger in females (2.49±0.855) than males (2.26±1.13). The stomach was the most common site for GIST followed by the Small bowel and rectum. The majority of the tumours were spindle cell. This study reports 12 different types of mutation among 39 KIT, 8 PDGFRA and 7 BRAF mutations. In KIT, the most prevalent was exon 11 mutation with the KITdelinc557/558 (14/30) being the major exon 11 type mutation. In PDGRFA, five exons 18 with p.D842V substitution and three exons 12 deletion mutation was reported. Seven patients had strong or diffuse BRAF staining having V600E type mutation as major BRAF type mutation. Drug-resistant GIST due to acquired mutations remains a serious issue, therefore genetic information of such mutational related to drug-resistant may provide the imperative clue for diagnosis and clinical treatment. These mutations are pivotal for prognosis and associated with imatinib as not all of them but only a few are reported resistant to the imatinib.

Clinic-pathological aspect of gastro-intestinal stromal tumors at tertiary care Hospital India

BackgroundThis study defines the disease profile in south Indian population and determine the clinic-pathological aspects of Gastro-Intestinal Stromal Tumors. MethodIn this prospective study patients diagnosed of gastrointestinal stromal tumors were taken thorough clinical examination and a database of Anthropometric details and clinical details were analyzed. Pathological data included tumor size, presence or absence necrosis, mitotic counts, immunohistochemistry for CD-117, CD-34. ResultsThere were 44 patients with confirmed diagnosis of gastro-intestinal stromal tumor. The highest incidence was found in the 6th decade. The most common symptoms were abdominal pain and gastrointestinal bleed. Stomach was most frequent site for gastro-intestinal stromal tumors. Immunochemistry for CD-117 was positive in 93.18% cases. Majority of tumors (79.5%) had pure spindle cell morphology and mitotic activity showed that 34% of the GISTs were of the high risk group. Forty two patients were suggestive of surgery as the primary treatment after presentation. ConclusionAbdominal pain was the most common presenting complaint. Majority of the tumors aroused from the stomach. The majority of the tumors had pure spindle cell morphology and 93% of the tumors were CD-117 positive. A significant relationship between tumor size, tumor necrosis and mitotic activity with large tumors having necrosis and high mitotic rate having high risk of malignancy, was observed. Surgical resection is considered mainstay of treatment of gastro-intestinal stromal tumor. Imatinib therapy should be given to patients in moderate to severe risk categories.

Clinicopathological Outcomes and Prognosis of Elderly Patients (≥ 65 Years) with Gastric Gastrointestinal Stromal Tumors (GISTs) Undergoing Curative-Intent Resection: a Multicenter Data Review

BackgroundThe most common site of gastrointestinal stromal tumors (GISTs) is the stomach, and gastric GISTs (gGISTs) occur most often in elderly patients. However, the clinicopathological features, treatment patterns, and prognosis of elderly patients with gGISTs remain unclear. MethodsWe retrospectively collected clinicopathological and prognostic data for patients with primary gGISTs who underwent curative-intent resection at 10 medical centers in China from 1998 to 2015. ResultsOver the 18 years, 10 medical centers treated 1846 patients with primary gGISTs by curative-intent resection. The median age was 59 (range 18–91) years. The patients were classified into two groups according to age, namely an elderly group (≥ 65 years of age) and a nonelderly group (< 65 years of age). The elderly group had more comorbidities (40.7% vs 23.5%, p = 0.011), a higher rate of postoperative complications (14.4% vs 8.7%, p = 0.031), and a lower proportion of intermediate/high-risk patients who received adjuvant therapy (30.0% vs 66.8%, p = 0.001) than did the nonelderly group. Regarding pathological outcomes, a significant difference in tumor necrosis was observed between the two groups (p = 0.002), and more cases of tumor necrosis occurred in the elderly group than in the nonelderly group. Regarding postoperative recovery outcomes, no significant difference was observed between the two groups. Univariate analysis showed that age, postoperative complications, adjuvant therapy, tumor size, mitotic count, modified National Institutes of Health (NIH) risk category, and tumor necrosis were factors that affected disease-free survival (DFS). Multivariate analysis showed that modified NIH risk category was the only independent factor affecting DFS. The 5-year DFS rates in the nonelderly and elderly groups were 88.1% and 81.4%, respectively (p = 0.034), and the 5-year overall survival (OS) rates were 90.4% and 85.5% (p = 0.038), respectively. ConclusionsCurrently, the treatment patterns for elderly patients with gGISTs remain the same as those for young patients with gGISTs. Elderly gGIST patients had more comorbidities and postoperative complications than did nonelderly gGIST patients, and fewer elderly gGIST patients received postoperative adjuvant therapy. Elderly gGIST patients also had a higher rate of tumor necrosis and worse DFS and OS than did young gGIST patients. Further exploration into the diagnosis and treatment patterns of elderly patients is therefore essential.

Gastrointestinal Stromal Tumor (GIST): An Update on Its Uncommon and Complex Presentations: A Short Review

Gastrointestinal stromal tumor (GIST) is recently diagnosed as a tumor entity. In the past, these tumors were classified as leiomyomas, leiomyosarcomas and leiomyoblastomas. 1 GISTs are the rare soft tissue sarcomas of the gastrointestinal tract (GIT), accounting for 0.1-3% of all GIT tumors. 2 The most common site of GIST is the stomach (60-70%) followed by small intestine (20-30%) and less common than 5% in colon, esophagus, omentum and mesentry. 3 The epidemiology of GIST is not known completely. Most often these cases were detected on endoscopy, on imaging of the abdomen, at surgery for the other condition or at autopsy. 1 The varied clinical presentations depend on the size of the tumor. Small GIST (less than 2cms) are asymptomatic and incidentally detected at endoscopy or at laparotomy. 1 The large tumors give rise to vague abdominal discomfort or pain (20-50%), acute or chronic GI bleeding, intestinal obstruction (20%) or altered bowel habits and about 35% are detected incidentally. As per literature, the most common (50%) presentation is bleeding. Very large or malignant GIST presented as the exophytic palpable mass. 1 Regarding unusual and complex presentations of GIST, we encountered two cases of GISTs in the ten years of histopathology practice. DOI: 10.21276/AABS.2017.1330

Pancreatic GIST in a Patient with Limited Stage Small Cell Lung Cancer: A Case Report and Review of Published Cases

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract and usually occur in the stomach and the small intestine. The pancreas is an extremely rare primary site for GISTs and there are 25 reported cases of pancreatic GIST with most being treated with surgical resection. We describe a 52-year-old African-American female who was diagnosed with limited stage small cell carcinoma in November 2009 and treated with concurrent cisplatin/etoposide chemotherapy and radiation. She subsequently achieved complete remission. Two years later she was diagnosed with localized pancreatic GIST by endoscopic ultrasonography guided fine needle aspiration. We treated her with a tyrosine kinase inhibitor (TKI) imatinib 400 mg oral dose daily as she declined surgery. Her disease is stable based on computed tomography imaging scans 40 months after diagnosis without any metastasis. To the best of our knowledge, our case is the second case of localized pancreatic GIST treated with TKI monotherapy.

The importance of mutational status in prognosis and therapy of GIST

GIST (gastrointestinal stromal tumor) are the most common mesenchymal tumors in gastrointestinal tract and are thought to derive from the cells of Cajal or their precursors that have a constitutional mutation in KIT and PDGFRA genes. There are KIT and PDGFRA genes mutations detected before the start of therapy that are believed to be related to GIST pathogenesis and some secondary mutations causing drug resistance and progression of disease. The most common KIT mutations are detected in exon 11 (66-71%), exon 9 (10-13%), exon 13,14,17 (1% each). PDGFRA mutations (8%) are described in exon 18 (5-6%), 12 (1%) and 14 (1%). No mutations are detected in 5-10% of tumors and those subtypes are called wild type GIST (WT). Imatinib mesilate is a selective inhibitor of KIT and PDGFRA with an antityrosine kinase activity (TKI) used in advanced or metastatic GIST as well as in adjuvant setting after complete resection of neoplasm. Imatinib has radically changed the therapy and prognosis of GIST, but sensitivity of the disease is different on the basis of leading mutations. GIST KIT exon 11 mutated manifests response rate in 80% of cases, exon 9 in 40% and GIST WT in 14%. PDGFRA shows a mild sensitivity to drug (66%) except the exon 18 D842 V mutation which is totally resistant. Unfortunately up to 15% of GIST have a primary resistance to imatinib that means progression of the disease within 6-12 months after the start of therapy. Another 40-50% of GIST develops a secondary resistance after >24 months of TKI treatment. Biopsy of progressing GIST shows multiple clonal origins with distinct mutational changes. Secondary resistance occurs almost exclusively in KIT mutated GIST with the appearances of T670I gatekeeper secondary mutation and less common in 14, 17, 18 exons. After progression of disease second line therapy is represented by sunitinib malate that overcomes the most common resistant mutations excepted PGDFRA D842V. Again, after few months of treatment, new different mutations appear and the disease progresses. Regorafenib is the third line therapy but too few data relates mutational status and regorafenib activity. In adjuvant setting only imatinib has a role. Two important studies (the USA ACOSOG Z 9001 and the German-Scandinavian study) fail to demonstrate that a specific mutation can predict a better DFS and OS in treated patients. On the contrary, volume of the tumor, number of mitosis and site of GIST are strong prognostic and predictive factors. In conclusion mutational analysis in GIST is at present more useful in metastatic setting than in adjuvant therapy. The insurgence of primary and secondary mutations during therapy is a fundamental step for disease progression.

Robotic gastric resection of large gastrointestinal stromal tumors

BackgroundThe stomach is the most common site for gastrointestinal stromal tumors (GIST) development. Surgical treatment consists of excision of the entire neoplastic mass, with sufficient surgical margins within healthy tissue. This can be achieved with different techniques ranging from wedge resections, typical gastric resections, right up to total gastrectomy. There aren't clear guidelines for the use of minimally invasive approach. Materials and methodsFrom January 2011 to April 2012, 5 patients with presumed preoperative diagnosis of GIST were treated by robotic surgery at the Unit of Surgery and Advanced Oncologic Therapies, Forlì Hospital, Forlì, Italy. We report operative techniques, perioperative outcomes and follow-up. ResultsLesions were localized at anterior wall of gastric antrum (N = 2) and near pyloric area (N = 3). Mean tumor size was 5 cm (range 4–7 cm). Surgical procedures were 5 distal gastrectomy. None intervention was converted to open surgery and there weren't major intraoperative complications. Median operative time was 240 min (range 210–300 min) and mean intraoperative blood loss was 96 ml (80–120 ml). All lesions had microscopically negative resection margins. Median follow-up was 13.5 months (range 12–15 months) with a disease-free survival rate of 100%. ConclusionsSurgical robotic approach for large GISTs is feasibility and new evidences are needed to clarify the effective role of different surgical strategies.

Gastrointestinal Stromal Tumor of the Rectum: Results of Surgical and Multimodality Therapy in the Era of Imatinib

The rectum is a rare site of gastrointestinal stromal tumor (GIST), and factors determining long-term outcome remain unclear. In a population study, we assessed the outcome of rectal GIST patients treated at two referral centers. A total of 39 patients diagnosed with rectal GIST between January 2002 and December 2010 were identified in prospective databases. Tumor and patient characteristics, treatment details, and outcome were evaluated. Median follow-up was 41 (3-110) months. A male predominance was noticed (M/F = 29/10). Median age was 53 years (range, 32-80 years). The cohort included, of 39 patients, 12 low-risk, 26 high-risk, and 1 with M1 disease. Of 38 patients with nonmetastatic disease, 36 underwent surgery as transabdominal (15 of 36) or local (21 of 36) resection. There were 21 patients who received preoperative and/or postoperative imatinib treatment. Patients with preoperative imatinib (16 of 36) had a significantly higher rate of R0 resections (p = .02). Five patients developed local recurrences. All of them had undergone local tumor excision with positive margins and without perioperative imatinib. Also, five patients suffered from distant metastases. All belonged to the high-risk group and underwent tumor surgery (3 R0, 2 R1) without receiving perioperative imatinib. A total of three patients died of disease. Perioperative imatinib was associated with improved local disease-free, disease-free, and overall survival (p < .01, p < .01, and p = .03, respectively). Local disease-free survival was significantly improved by negative resection margins (p < .01). Complete resection is recommended to achieve local disease control. Preoperative imatinib was associated with improved surgical margins. Perioperative imatinib was associated with improved local disease-free, disease-free, and overall survival.

Management of liver metastases of gastrointestinal stromal tumor

Liver is the most common metastatic site of gastrointestinal stromal tumor(GIST). The recurrence rate is high even after hepatectomy. Although tyrosine kinase inhibitors (TKI) makes the resection feasible for some of the liver metastasis of GIST and significantly increase the overall survival, surgery still can not be substituted. Therefore, it is worth investigating and exploring the most appropriate treatment for the GIST with liver metastasis.

Duodenal GIST: a single center experience

PurposeThe duodenum as primary site for gastrointestinal stromal tumors (GISTs) is rare and mitotic rate, tumor size, type of mutation and number of chromosomal aberrations have prognostic implications.MethodsWe analyzed the outcome of 13 patients with duodenal GISTs who underwent surgical tumor resection. Either segmental duodenectomy or pylorus-preserving duodenopancreatectomy was performed. The tumors were histopathologically examined and the risk of progression was assessed based on tumor size and mitotic count. Additionally, mutation analysis of the KIT and PDGFRA receptor tyrosine kinase genes and comparative genomic hybridization (CGH) were performed in all cases.ResultsEight patients underwent segmental duodenectomy and five patients were treated with pylorus-preserving duodenopancreatectomy. None of the five GISTs with low or no risk for malignancy according to the Miettinen classification developed tumor progress. In contrast, five of eight cases (62.5%) with high-risk tumors revealed tumor progress, and four of these patients died (50%). The median overall survival for all patients was 66 months, and the median disease-free survival 41 months. The operative procedure and type of mutation did not correlate with long-term survival. CGH analysis displayed −15q in 12/13 tumors, and −1p in 11/13 cases as characteristic chromosomal aberrations for intestinal origin. Notably, −22q was present in three of four cases with tumor progress.ConclusionsBoth segmental duodenectomy and pylorus-preserving duodenopancreatectomy are appropriate options to treat duodenal GIST and should be implemented depending on resectability and the patient's performing state. The Miettinen classification and CGH findings correlate with the clinical course.

Surgical outcomes of gastrointestinal stromal tumors of the stomach: a single unit experience in the era of targeted drug therapy

The stomach is the most common site of gastrointestinal stromal tumors (GISTs), but the surgical outcomes of gastric GISTs in the era of targeted drug therapy are unclear. This study aimed to assess factors associated with adverse outcomes and to analyze the effects of targeted drug therapy on gastric GISTs. The surgical outcomes and follow-up records of consecutive patients with gastric GISTs treated at Tianjin Medical University Cancer Institute & Hospital between June 2002 and December 2008 were reviewed. Eighty-five patients were included. Surgery was undertaken in all patients with curative intent. Imatinib mesylate was administered preoperatively to 6 (7%) patients (neoadjuvant therapy), and the median durations of therapy were 6 months (range 3-17 months). Imatinib mesylate was administered postoperatively to 18 (21%) patients with high-risk lesions (adjuvant therapy) and 19 (22%) patients with recurrent disease, and the median durations of therapy were 22 months (range 6-24 months) and 25 months (range 1-64 months), respectively. Tumor size greater than 10 cm (P = 0.015), high mitotic index (P = 0.021), and no adjuvant imatinib therapy (P = 0.046) were the only significant factors associated with higher recurrence-free survival in multivariate analysis. Large tumors, high mitotic index, and the absence of imatinib treatment are associated with high recurrence-free survival. Adjuvant imatinib therapy of 2 years appears to decrease the recurrence of gastric GISTs.

A Case Report of a Metastatic Gastrointestinal Stromal Tumor Occurring in Femur

Gastrointestinal stromal tumors (GISTs) are mesenchymal neoplasms that most commonly affect the stomach or small intestine, but can occur anywhere throughout the gastrointestinal tract. To the best of our knowledge, few cases have been reported in the literature about the femur metastasis of GIST. This paper describes a metastasis of a gastrointestinal stromal tumour (GIST) to the femur in a 62-year-old male, 2 years after treatment for a gastric primary. There were no signs of tumor recurrence at followup after 12 mo. This case suggests that the femur can be a potential metastatic site of GIST.

Different Sites and Prognoses of Gastrointestinal Stromal Tumors of the Stomach: Report of 187 Cases

The stomach is the most common site of gastrointestinal stromal tumors (GISTs), but the clinical behavior of gastric GISTs at different sites is unclear. This study was designed to evaluate the clinicopathological (CP) parameters and influence of different gastric sites on outcome in patients with GIST. The CP and follow-up records of 187 patients with GIST who were treated at TianJin Medical University Cancer Institute & Hospital between January 1985 and December 2006 were reviewed. There were 97 men and 90 women (aged 17-88 (median, 56.5) years). CP factors were assessed for overall survival (OS) by using univariate and multivariate analysis. The numbers of cases of upper, middle, and lower third gastric GISTs were 69 (36.9%), 103 (55.1%), and 15 (8%), respectively. Sites of GISTs in the middle or upper stomach, tumor size, intermediate- or high-risk groups, high mitotic count, and low resection status were associated with poor OS (p = 0.041, 0.046, 0.006, 0.000, 0.000, respectively) in a univariate analysis. In a multivariate analysis, tumor location in the upper and middle third of the stomach (p = 0.035), an intermediate or high risk (p = 0.01), and incomplete resection status (p = 0.006) were predictive of poor OS. Patients in intermediate- and high-risk groups had an unfavorable outcome. A complete resection is the most important treatment for survival. The location of GIST in the lower third of the stomach may be a favorable factor, and the significance of different tumor sites for prognosis of gastric GISTs needs to be further clarified.

Comparison of Clinical Characteristics between Open and Laparoscopic Surgery Groups in Gastric Gastrointestinal Stromal Tumor Patients

Purpose: The stomach is the most frequent site of gastrointestinal stromal tumor (GIST). Surgery remains the only curative treatment for GIST. Resection needs to ensure tumor free margin without lymphadenectomy. Thus partial gastric resection is the treatment of choice for gastric GIST. This study aims to review clinical characteristics between open and laparoscopic wedge resection group and evaluate safety and efficacy of laparoscopic wedge resection. Methods: Between 1997 and 2008, 74 consecutive patients undergoing open or laparoscopic wedge resection of gastric GISTs were identified in a retrospectively collected database. Preoperative and postoperative variables were analyzed. Results: Wedge resection with negative margin was performed in 74 patients. Laparoscopic wedge resection was performed 19 patients. Open wedge resection was performed in 55 patients. Mean tumor size of laparoscopic group was 2.7 ㎝ (range 0.4∼6.0) and open group was 4.4 cm (range 0.4∼23.0). Mean operation time of laparoscopic group was 150.0 minutes (range 80∼240), and open group was 164.6 minutes (range 75∼360). Mean hospital stay of laparoscopic group was 7.11 days (range 3∼19), and open group was 9.38 days (range 6∼20). There were no significant survival differences between groups. Conclusion: A laparoscopic wedge resection of gastric GIST is associated with short hospitalization and not inferior to open wedge resection in terms of morbidity and mortality. The long-term outcomes between laparoscopic and open wedge resection group in our study were no significant survival differences. Long-term and prospective randomized study should be performed to confirm oncological safety of laparoscopic wedge resection.

Gastrointestinal Stromal Tumor of the Small Intestine: A Clinicopathologic Study of 70 Cases in the Postimatinib Era

The small intestine, after the stomach, is the second most common primary site for gastrointestinal stromal tumors (GISTs). This study aimed to identify clinicopathologic prognostic factors of tumor recurrence and survival and to analyze the influence of imatinib and sunitinib for small-intestine GISTs. We reviewed the surgical experience of patients with small-intestine GISTs at National Taiwan University Hospital from January 1995 to March 2007. We analyzed the perioperative clinicopathologic data and treatment course. Seventy patients were included. The tumor was local in 43 patients, advanced in 21 patients, and 6 had metastasis. The median size of the tumor was 6.5 cm. Forty-four patients had a mitotic rate of less than 5/50 high-power field. The 1-year and 5-year disease-free survival rates were 85 and 66.7%, respectively, while the 1-year and 5-year overall survival rates were 98.5 and 86.6%, respectively. There were 19 patients with recurrent disease and 6 patients died of intestinal GISTs. The response rate of imatinib and sunitinib were 73.3 and 60%, respectively. According to multivariate analysis for disease recurrence, only invasion status, tumor size, and mitotic rate are significant (P=0.007, 0.035, 0.007 respectively). They are also associated with poor survival (P<or=0.001, 0.006, 0.002, respectively). The invasion status, size, and mitotic rate of tumor involve higher risk of recurrence and poor survival in small-intestine GISTs. The patients with recurrent small-intestine GISTs may have a lower mortality rate after using imatinib and sunitinib.

Hemoperitoneum due to Ruptured Gastric Gastrointestinal Stromal Tumor

The stomach is the most frequent site of gastrointestinal stromal tumor (GIST). The common clinical manifestation of GIST are melena and hematochezia caused by gastointestinal bleeding. However, hemoperitoneum due to GIST rupture is a very rare condition. We describe a 33-year-old man with gastric GIST causing hemoperitoneum. A preoperative CT scan demonstrated large amount of fluid collection and extraluminal mass lesion in gastric antral area. He underwent an emergent laparotomy. The antral mass was polypoid shaped and showed ruptured focus. We performed a distal gastrectomy. The tumor was revealed as GIST with intermediate malignant risk by pathologic examination. The patient had an uneventful postoperative course and remains well.