Gervaz P, Huber O, Morel P
Department of Surgery, University Hospital Geneva, Geneva, Switzerland.
Br J Surg. 2009 Jun;96(6):567-78. doi: 10.1002/bjs.6601.
Over the past decade, gastrointestinal stromal tumours (GISTs) have served as a model for the application of tyrosine kinase inhibitors in the treatment of solid neoplasms. Operative and medical management of GISTs is rapidly evolving, but current guidelines appear restricted to basic non-organ-specific recommendations.
A PubMed search was made of the English literature from 1998 to 2008 for references containing the terms 'gastrointestinal stromal tumours' and 'surgery'. This paper reviews the various operative strategies so far reported for GISTs within the digestive tract.
Many original procedures tailored to the specific characteristics of these rare sarcomas have been reported. GISTs exhibit distinct features, in particular an absence of metastases within locoregional lymph nodes. Operations requiring extended lymph node dissection, typically designed for adenocarcinomas, such as gastrectomy with extended lymph node dissection, Whipple's procedure and total mesorectum excision, are inappropriate for treating GISTs originating from the stomach, duodenum and rectum respectively.
GISTs allow the possibility of performing oncologically adequate but limited (wedge; segmental) resections. Such surgery can be carried out in a variety of ways, such as open, laparoscopic, trans-sacral or endoscopic.
在过去十年中，胃肠道间质瘤（GISTs）已成为酪氨酸激酶抑制剂应用于实体肿瘤治疗的一个范例。GISTs的手术和药物治疗正在迅速发展，但目前的指南似乎仅限于基本的非器官特异性建议。
对1998年至2008年的英文文献进行PubMed检索，以查找包含“胃肠道间质瘤”和“手术”等术语的参考文献。本文回顾了迄今为止报道的针对消化道GISTs的各种手术策略。
已经报道了许多针对这些罕见肉瘤的特定特征量身定制的原始手术方法。GISTs具有独特的特征，特别是局部区域淋巴结内无转移。需要广泛淋巴结清扫的手术，通常是为腺癌设计的，如扩大淋巴结清扫的胃切除术、惠普尔手术和全直肠系膜切除术，分别不适用于治疗起源于胃、十二指肠和直肠的GISTs。
GISTs使得进行肿瘤学上足够但有限（楔形；节段性）切除成为可能。这种手术可以通过多种方式进行，如开放手术、腹腔镜手术、经骶骨手术或内镜手术。
