Sujendran V, Fearnhead N, De Pennington N, Warren B F, Maynard N D
Department of Upper Gl Surgery and Pathology, The John Radcliffe Hospital, Headington, Oxford, UK.
Surgeon. 2007 Jun;5(3):149-53. doi: 10.1016/s1479-666x(07)80042-4.
It has been reported that gastric gastrointestinal stromal tumours (GIST) are aggressive, rare and difficult to treat. Some have advocated radical resection as the only potential cure. We present data to support treatment of gastric GISTs with a limited surgical approach and minimal morbidity. Furthermore, we propose that surveillance for recurrence is unnecessary based upon the follow-up of a cohort of patients with gastric GISTs.
Database and case notes analysis of 20 patients diagnosed with gastric GIST (1998-2004) and managed by one surgeon in a single centre over seven years. Main outcome measures were inpatient adverse events, positive resection margins and symptom free survival.
Three cases have been managed with surveillance only. Successful resection was performed in 17 patients without mortality. No patient had positive margins on histological assessment. Fifteen out of seventeen samples were positive for the c-Kit proto-oncogene (CD117) and 14117 positive for CD34. Only two patients required en-bloc resections due to the tumour size and involvement of adjacent structures. One patient developed metastatic disease during follow-up of 19-86 months.
We recommend local excision of gastric GISTs to allow macroscopically clear margins. This policy then allows symptomatic follow-up due to the indolent nature of the majority of the tumours resected. A tailored follow-up with endoscopy and radiological imaging has been advocated by others but appears unnecessary in most cases. Imatinib (anti c-Kit) can now be offered to patients presenting with recurrent GIST, if further surgery is deemed inappropriate.
据报道，胃胃肠道间质瘤（GIST）具有侵袭性、罕见且难以治疗。一些人主张根治性切除是唯一可能的治愈方法。我们提供数据以支持采用有限手术方法和最低发病率来治疗胃GIST。此外，基于对一组胃GIST患者的随访，我们提出无需进行复发监测。
对20例1998 - 2004年诊断为胃GIST并由一位外科医生在单一中心管理了7年的患者进行数据库和病例记录分析。主要观察指标为住院不良事件、手术切缘阳性情况和无症生存。
3例仅进行了监测。17例患者成功进行了切除，无死亡病例。组织学评估中无患者切缘阳性。17个样本中有15个c-Kit原癌基因（CD117）呈阳性，14/17个CD34呈阳性。仅2例因肿瘤大小和累及相邻结构需要整块切除。1例患者在19 - 86个月的随访期间发生了转移性疾病。
我们建议对胃GIST进行局部切除以获得宏观上清晰的切缘。由于大多数切除的肿瘤生长缓慢，该策略允许进行症状性随访。其他人主张采用内镜和影像学检查进行针对性随访，但在大多数情况下似乎没有必要。如果认为进一步手术不合适，现在可以为复发性GIST患者提供伊马替尼（抗c-Kit）治疗。
