Sarcoma and Mesenchymal Tumors Unit, General Surgery Service, "La Arrixaca" Clinical University Hospital, Murcia, Spain.
Bariatric Surgery Unit, General Surgery Service, "La Arrixaca" Clinical University Hospital, Murcia, Spain.
Obes Surg. 2020 Nov;30(11):4529-4541. doi: 10.1007/s11695-020-04853-1. Epub 2020 Jul 24.
The number of bariatric procedures has increased notably, with incidental findings such as gastrointestinal stromal tumors (GISTs) being observed in 2%. The number of studies dealing with incidental findings during bariatric surgery (BS), especially GISTs, is scarce. This review aims to summarize the evidence about GIST diagnosis during BS, and to establish recommendations for the management and follow-up of these patients. A systematic literature search from January 2000 to March 2020 was performed. Retrospective cohort studies, case series, case reports, reviews, and conference abstracts were considered eligible. The present systematic review focused on a descriptive analysis of the data included in the articles selected. The calculated incidence was 0.65%. A change in operative plan was observed in 5% of the cases. In 98% of the cases, GISTs were gastric, with a mean size of 10.3 mm. The mitotic index was < 5 in 99%. Accordingly, all patients were classified as having a very low or low risk of recurrence. R0 resection was achieved in 100% of cases. The incidence of GISTs in patients with MO submitted to BS is considerably higher than in the general population. The diagnosis is related to the depth of preoperative work, the exhaustiveness of the intraoperative examination, and the meticulousness of the histopathological analysis. Although GISTs have a low risk of recurrence and it was previously unnecessary to modify the surgical technique, we recommend that bariatric surgeons are aware of the diagnosis and management of incidental GISTs.
减重手术数量显著增加，2%的患者偶然发现胃肠道间质瘤（GIST）。目前关于减重手术中偶然发现（包括 GIST）的研究很少。本综述旨在总结 GIST 在 BS 中的诊断证据，并为这些患者的管理和随访提供建议。从 2000 年 1 月到 2020 年 3 月进行了系统的文献检索。回顾性队列研究、病例系列、病例报告、综述和会议摘要被认为符合条件。本系统综述重点对所选文章中包含的数据进行描述性分析。计算的发病率为 0.65%。手术计划的改变在 5%的病例中观察到。在 98%的病例中，GIST 位于胃内，平均大小为 10.3mm。有丝分裂指数<5%。因此，所有患者均被归类为复发风险极低或低。在 100%的病例中达到了 R0 切除。接受 BS 的 MO 患者的 GIST 发病率明显高于一般人群。诊断与术前工作的深度、术中检查的全面性和组织病理学分析的细致性有关。尽管 GIST 复发风险较低，且以前不需要改变手术技术，但我们建议减重外科医生了解偶然发现的 GIST 的诊断和管理。
