Robb W B, Bruyere E, Amielh D, Vinatier E, Mabrut J Y, Perniceni T, Piessen G, Mariette Christophe
*Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Lille, France †North of France University, Lille, France ‡Integrated Research Center in Oncology: SIRIC ONCOLille, Lille, France §Inserm, UMR837, Jean-Pierre Aubert Research Center, Team 5 Mucins, Epithelial Differentiation and Carcinogenesis, Lille, France ¶University Hospital Croix-Rousse, Lyon, France ∥Institut Mutualiste Montsouris, Paris, France.
Ann Surg. 2015 Jan;261(1):117-24. doi: 10.1097/SLA.0000000000000505.
The primary objective was to evaluate the feasibility of surgical enucleation of esophageal gastrointestinal stromal tumors (E-GISTs). Secondary objectives evaluated (i) the impact of tumor enucleation on oncological outcomes, (ii) the effect of pretherapeutic biopsy on the feasibility of E-GIST enucleation, and (iii) the impact of mucosal ulceration on outcome.
E-GISTs are very rare tumors and esophageal resection has been the recommended approach. The feasibility and impact on outcomes of tumor enucleation are unknown.
Through a large national multicenter retrospective study, 19 patients with E-GISTs were identified between 2001 and 2010. Patients who underwent either enucleation or esophagectomy were compared.
Of over 19 patients identified with E-GISTs, curative treatment was surgical for 16 patients, with enucleation in 8 and esophagectomy in 8. In the enucleation group, median tumoral diameter was 40 mm (18-65 mm), without any mucosal ulceration, preoperative capsular ruptures, or incomplete resections. In the esophagectomy group, the median tumoral diameter was 85 mm (55-250 mm), with mucosal ulceration in 4 patients, preoperative capsular rupture in 1, and no incomplete resections. Severe postoperative complication rates were 50% and 25% in the esophagectomy and enucleation groups, respectively, with 2 postoperative deaths after esophagectomy. After a median follow-up of 6.4 years, 2 recurrences were observed after esophagectomy versus 0 after enucleation. Endoscopic biopsies did not expose patients to complications or local recurrence after enucleation. Endoscopic mucosal ulceration was associated with more aggressive tumors.
E-GIST enucleation seems safe for tumors of less than 65 mm in diameter.
主要目的是评估手术摘除食管胃肠道间质瘤（E-GISTs）的可行性。次要目的评估：（i）肿瘤摘除对肿瘤学结局的影响；（ii）治疗前活检对E-GIST摘除可行性的影响；（iii）黏膜溃疡对结局的影响。
E-GISTs是非常罕见的肿瘤，食管切除术一直是推荐的治疗方法。肿瘤摘除的可行性及其对结局的影响尚不清楚。
通过一项大型全国多中心回顾性研究，在2001年至2010年间确定了19例E-GISTs患者。对接受摘除术或食管切除术的患者进行比较。
在确诊的19例以上E-GISTs患者中，16例患者接受了根治性手术，其中8例行摘除术，8例行食管切除术。在摘除术组中，肿瘤中位直径为40mm（18 - 65mm），无黏膜溃疡、术前包膜破裂或切除不完全情况。在食管切除术组中，肿瘤中位直径为85mm（55 - 250mm），4例患者有黏膜溃疡，1例术前包膜破裂，无切除不完全情况。食管切除术组和摘除术组的严重术后并发症发生率分别为50%和25%，食管切除术后有2例患者死亡。中位随访6.4年后，食管切除术后观察到2例复发，而摘除术后无复发。内镜活检未使摘除术后的患者出现并发症或局部复发。内镜下黏膜溃疡与更具侵袭性的肿瘤相关。
对于直径小于65mm的肿瘤，E-GIST摘除术似乎是安全的。
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