非解剖性直肠切除术是否是直肠胃肠道间质瘤的有效治疗选择？一种建议的决策算法。

Is nonanatomic rectal resection a valid therapeutic option for rectal gastrointestinal stromal tumors? A proposed decision algorithm.

机构信息

Department of Digestive Surgery, Strasbourg University, Strasbourg, France.

Department of Digestive Surgery, Hôpital Pitié-Salpêtrière, Paris, France.

出版信息

J Surg Oncol. 2020 Dec;122(8):1639-1646. doi: 10.1002/jso.26215. Epub 2020 Sep 16.

DOI:10.1002/jso.26215

PMID:33184896

Abstract

BACKGROUND AND OBJECTIVES

The best surgical approach to rectal gastrointestinal stromal tumors (GISTs) is still debated, and both nonanatomic rectal resection (NARR) and anatomic rectal resection (ARR) are applied. The aim of this study was to evaluate the feasibility and oncological outcomes of NARR and ARR for rectal GISTs (R-GISTs).

METHODS

Through a large French multicentre retrospective study, 35 patients were treated for R-GIST between 2001 and 2013. Patients who underwent NARR and ARR were compared.

RESULTS

There were 23 (65.7%) patients in group ARR and 12 (34.3%) in group NARR. Significantly more patients in the group with ARR had a neoadjuvant treatment (86%) with tyrosine kinase inhibitor (TKI) (imatinib) compared to those with NARR (25%) (p < .01). The median preoperative tumor size was significantly different between the groups without and with neoadjuvant TKI: 30 ± 23 mm versus 64 ± 44.4 mm, respectively (p < .001). Overall postoperative morbidity was 20% (n = 7) (26% for ARR vs. 8% for NARR; p = .4). After a median follow-up of 60.2 (3.2-164.3) months, the 5-year disease-free survival rates were 79.5% (confidence interval [CI] 95%: 54-100) for the NARR group and 68% (CI 95%: 46.4-89.7) for the ARR group (p = .697), respectively.

CONCLUSION

The use of NARR for small R-GIST's does not seem to impair the oncological prognosis.

摘要

背景与目的

直肠胃肠道间质瘤（GIST）的最佳手术方法仍存在争议，非解剖直肠切除术（NARR）和解剖直肠切除术（ARR）均有应用。本研究旨在评估 NARR 和 ARR 治疗直肠 GIST（R-GIST）的可行性和肿瘤学结果。

方法

通过一项大型法国多中心回顾性研究，对 2001 年至 2013 年间接受 R-GIST 治疗的 35 名患者进行了治疗。比较了接受 NARR 和 ARR 的患者。

结果

ARR 组有 23 名（65.7%）患者，NARR 组有 12 名（34.3%）患者。ARR 组中有更多的患者接受了新辅助治疗（86%），使用了酪氨酸激酶抑制剂（TKI）（伊马替尼），而 NARR 组仅有 25%（p<.01）。无新辅助 TKI 和有新辅助 TKI 的两组患者的术前肿瘤大小中位数有显著差异：分别为 30±23mm 和 64±44.4mm（p<.001）。总的术后发病率为 20%（n=7）（ARR 组为 26%，NARR 组为 8%；p=0.4）。在中位随访 60.2（3.2-164.3）个月后，NARR 组的 5 年无病生存率为 79.5%（95%置信区间 [CI]：54-100），ARR 组为 68%（95%CI：46.4-89.7）（p=0.697）。