Department of General Surgery, Cairo University, Giza, Cairo 12311, Egypt.
Int J Surg. 2010;8(2):105-8. doi: 10.1016/j.ijsu.2009.09.016. Epub 2009 Nov 24.
Though recurrence is high, local excision is the preferred approach for dealing with gastric stromal tumors. Achieving negative margins is mandatory, sometimes requiring subtotal gastrectomy. Adjuvant imatinib is essential for advanced cases and prolonging survival; however, there is not enough data to recommend its use before surgery to increase resectability. The current study aims at investigating this concept in Egyptian patients.
The study included 16 patients (13 males, 3 females, mean age 60 years) presenting with gastrointestinal stromal tumors (GISTs) who were candidates for emergency (n = 3) or elective (n = 13) surgery. Investigations included endoscopy (+biopsy), sonography, and computed tomography (CT). Patients were enrolled in two groups: A (n = 6: projected to planned surgery) and B (n = 7: harboring c-kit +ve tumors). Each B patient received imatinib (400 mg/day) for 6 months before surgery. Clinical and radiological evaluation was at day 100. The Chi-square test was used to check size changes, and p at <0.02535 was considered significant.
All patients had abdominal discomfort, while 62.5% had epigastric pain, and 12.5% had hematemesis. Tumor sizes ranged from 8.4 to 20 cm 2/3 were located in the upper stomach. Five patients (31.3%) harbored lesions with low risk malignancy, eight (50%) with moderate risk and three (18.8%) with high risk. Wedge gastrectomy was the most common operation performed (81.25%) while partial gastrectomy was carried out in the rest, reporting no recurrence for 6 months. Not determined in group A patients, c-kit status was strongly positive in all members of group B; in two of them treatment was suspended due to poor response.
Imatinib has an acceptable safety profile and can be considered as a neoadjuvant therapy in GISTs. Until clear guidelines have been developed, we report that a 6 month intake may noticeably increase their resectability potential and improve prognosis.
尽管复发率较高，但局部切除仍是处理胃间质瘤的首选方法。必须达到阴性切缘，有时需要进行胃大部切除术。辅助伊马替尼对于晚期病例是必要的，可以延长生存时间；然而，目前尚无足够的数据推荐在手术前使用它来提高可切除性。本研究旨在调查埃及患者的这一概念。
该研究包括 16 名（男性 13 名，女性 3 名，平均年龄 60 岁）患有胃肠道间质瘤（GISTs）的患者，他们是急诊（n=3）或择期（n=13）手术的候选者。检查包括内窥镜检查（+活检）、超声检查和计算机断层扫描（CT）。患者分为两组：A 组（n=6：计划手术）和 B 组（n=7：携带 c-kit+肿瘤）。每位 B 组患者在手术前接受伊马替尼（400mg/天）治疗 6 个月。在第 100 天进行临床和影像学评估。使用卡方检验检查大小变化，p 值<0.02535 被认为具有统计学意义。
所有患者均有腹部不适，62.5%有上腹痛，12.5%有呕血。肿瘤大小范围为 8.4 至 20cm2/3 位于上胃。5 名患者（31.3%）患有低恶性肿瘤风险的病变，8 名（50%）患有中度风险，3 名（18.8%）患有高风险。楔形胃切除术是最常见的手术（81.25%），其余患者进行部分胃切除术，6 个月内无复发。A 组患者的 c-kit 状态未确定，B 组所有成员均为强阳性；其中两人因反应不佳而停止治疗。
伊马替尼具有可接受的安全性，可考虑作为 GIST 的新辅助治疗。在制定明确的指南之前，我们报告说，6 个月的摄入量可以显著提高其可切除性潜力并改善预后。
