Nagano Shinnosuke, Miyoshi Norikatsu, Takahashi Tsuyoshi, Itakura Hiroaki, Fujino Shiki, Ogino Takayuki, Takahashi Hidekazu, Uemura Mamoru, Matsuda Chu, Mizusima Tsunekazu, Mori Masaki, Doki Yuichiro
Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamadaoka, Suita City, Osaka 565-0871, Japan.
Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamadaoka, Suita City, Osaka 565-0871, Japan; Department of Innovatice Oncology Research and Regenerative Medicine, Osaka International Cancer Institute, 3-1-69 Ohtemae, Chuo-ku, Osaka 541-8567, Japan.
Int J Surg Case Rep. 2020;71:235-239. doi: 10.1016/j.ijscr.2020.05.031. Epub 2020 May 23.
Anus-preserving surgery for a large rectal gastrointestinal stromal tumor (GIST) may be difficult because of the location of the tumor in the pelvis. Therefore, rectal GIST might require extensive surgery, such as abdominoperineal resection. In recent years, preoperative imatinib therapy has been used to reduce tumor size and preserve the anus in some cases. However, there have been few reports of laparoscopic anal-preserving surgery for giant rectal GIST.
We present the case of a 55-year-old man who was referred to our hospital for examination of a 10-cm pelvic mass in the lower rectum. Endoscopic ultrasound with fine needle aspiration was performed, and the pathological findings resulted in a diagnosis of GIST. The mass had spread to the prostate and left levator ani muscles, and as a result, surgery was deemed difficult to perform without damaging the pseudo-capsule. Therefore, preoperative chemotherapy with imatinib mesylate (IM) was performed for 8 months. The mass was reduced to 7.8 cm, and laparoscopic intersphincteric resection (ISR) was performed.
We also review prior cases of rectal GIST where patients had undergone anal-preserving surgery following preoperative chemotherapy with IM. Our case represented the largest tumor size in a review of cases of patients who had successful anal-preserving laparoscopic surgery following preoperative chemotherapy with IM.
Preoperative chemotherapy with imatinib mesylate was effective for reducing the rectal GIST, and laparoscopic ISR was useful for anal preservation, even when a tumor is large.
由于直肠胃肠道间质瘤（GIST）位于盆腔，保留肛门的手术可能具有挑战性。因此，直肠GIST可能需要进行广泛的手术，如腹会阴联合切除术。近年来，术前伊马替尼治疗已被用于在某些情况下缩小肿瘤大小并保留肛门。然而，关于腹腔镜下保留肛门手术治疗巨大直肠GIST的报道较少。
我们报告一例55岁男性，因直肠下段10cm盆腔肿物转诊至我院。进行了内镜超声引导下细针穿刺活检，病理结果诊断为GIST。肿物已扩散至前列腺和左侧肛提肌，因此，若不损伤假包膜，手术难以实施。因此，给予甲磺酸伊马替尼（IM）术前化疗8个月。肿物缩小至7.8cm，随后进行了腹腔镜括约肌间切除术（ISR）。
我们还回顾了术前接受IM化疗后行保留肛门手术的直肠GIST既往病例。在回顾术前接受IM化疗后成功实施保留肛门腹腔镜手术的患者病例中，我们的病例代表了最大的肿瘤尺寸。
甲磺酸伊马替尼术前化疗对于缩小直肠GIST有效，即使肿瘤较大，腹腔镜ISR对于保留肛门也很有用。
