Lyros Orestis, Moulla Yusef, Mehdorn Matthias, Schierle Katrin, Sucher Robert, Dietrich Arne
Division of Bariatric Surgery, Clinic of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital, Liebigstrasse. 20, D-4015, Leipzig, Germany.
Institute of Pathology, University Hospital Leipzig, Leipzig, Germany.
Obes Surg. 2019 Jun;29(6):1858-1866. doi: 10.1007/s11695-019-03782-y.
Intraoperative pathologic findings during bariatric surgery are relatively rare. Gastrointestinal stromal tumors (GISTs) are commonly located in the stomach and account for < 1% of all neoplasms of the alimentary tract. Coincidental detection of GISTs during bariatric surgery has been reported around 0.8%. We analyzed the incidence of GISTs in bariatric patients and investigated whether simultaneous resection can be oncologically adequate.
MATERIAL/METHODS: A single-center retrospective study of 707 morbidly obese patients, who underwent bariatric surgery (either Roux-en-Y gastric bypass (RYGB), One Anastomosis Gastric Bypass (OAGB), or sleeve resection (LSG) between January 2012 and August 2018). Intraoperative incidental GISTs were recorded and documented for tumor size, localization, immunoreactivity, and mitotic index.
Nine (1.27%) patients were identified with GISTs. Seven (78%) tumors were detected in women; mean age 55.6 (range 27-74), mean BMI 51.7 mg/m2 (range 38-71). GISTs were predominantly located in the stomach (78%) and two (22%) within the small bowel; six were found during RYGB vs. three during LSG. No abort of surgery or change of the intended procedure was necessary. All tumors (0.2-3.7 cm) were resected with disease-free surgical margins and displayed low malignancy. No adjuvant therapy was necessary.
The incidence of incidental GISTs in our series was higher to what has already been reported. Risk of malignancy was low and resection as part of the bariatric procedure was considered as definitive treatment. Suspicious tumors should be removed and confirmed by histology. In case of GIST histology, tumor resection with negative margins may be weighed as complete oncological treatment if there is low risk of malignancy.
减肥手术中的术中病理发现相对少见。胃肠道间质瘤（GIST）通常位于胃，占消化道所有肿瘤的不到1%。据报道，减肥手术期间偶然发现GIST的发生率约为0.8%。我们分析了减肥患者中GIST的发生率，并研究了同期切除在肿瘤学上是否足够。
材料/方法：对2012年1月至2018年8月期间接受减肥手术（ Roux-en-Y胃旁路术（RYGB）、单吻合口胃旁路术（OAGB）或袖状切除术（LSG））的707例病态肥胖患者进行单中心回顾性研究。记录术中偶然发现的GIST，并记录肿瘤大小、定位、免疫反应性和有丝分裂指数。
9例（1.27%）患者被确诊为GIST。7例（78%）肿瘤在女性中被发现；平均年龄55.6岁（范围27 - 74岁），平均体重指数51.7mg/m2（范围38 - 71）。GIST主要位于胃（78%），2例（22%）位于小肠；RYGB期间发现6例，LSG期间发现3例。无需中止手术或改变预定手术方案。所有肿瘤（0.2 - 3.7cm）均在无瘤手术切缘情况下切除，且显示低恶性程度。无需辅助治疗。
我们系列研究中偶然发现GIST的发生率高于已报道的发生率。恶性风险低，作为减肥手术一部分的切除被视为确定性治疗。可疑肿瘤应切除并经组织学证实。如果是GIST组织学，若恶性风险低，切缘阴性的肿瘤切除可被视为完整的肿瘤学治疗。
