Matsui Yuki, Nishimura Junichi, Fujii Yoshiaki, Shinno Naoki, Hara Hisashi, Kanemura Takashi, Hasegawa Shinichiro, Akita Hirofumi, Haraguchi Naotsugu, Wada Hiroshi, Matsuda Chu, Yasui Masayoshi, Omori Takeshi, Miyata Hiroshi, Oue Masayuki
Dept. of Digestive Surgery, Osaka International Cancer Institute.
Gan To Kagaku Ryoho. 2022 Dec;49(13):1684-1686.
The gastrointestinal stromal tumor(GIST)guidelines state that the use of neoadjuvant chemotherapy(NAC)for curable GIST is not apparent. However, NAC is performed for massive rectal GIST at our hospital to reduce surgical invasion and improve surgical results. The cases were a 39-year-old man, a 48-year-old man, and a 78-year-old man. The site was Rb in all cases, and the maximum diameters at the rectal GIST diagnosis were respectively 70 mm, 75 mm, and 60 mm, which were massive tumors. Imatinib mesylate(imatinib)was started as NAC. The duration of NAC was respectively 6, 11, and 12 months. The maximum tumor diameter on preoperative CT was smaller than before NAC, and the average reduction rate was 23%. Two cases underwent laparoscopic abdominal perineal resection, and 1 underwent laparoscopic ultra-low anterior resection and ileostomy. No perioperative complications of Clavien-Dindo classification Grade Ⅱ or higher were unsettled. All patients were in the high risk group and received imatinib as postoperative adjuvant chemotherapy. Currently, respectively 2 years and 3 months, 1 year and 2 months, and 1 year after surgery, all are alive without recurrence. NAC with imatinib has contributed to minimally invasive and radical surgery for giant rectal GIST.
胃肠道间质瘤（GIST）诊疗指南指出，对于可治愈的GIST，新辅助化疗（NAC）的应用尚无明确依据。然而，我院对巨大直肠GIST进行NAC以减少手术侵袭并改善手术效果。病例包括一名39岁男性、一名48岁男性和一名78岁男性。所有病例的病变部位均为Rb，直肠GIST诊断时的最大直径分别为70mm、75mm和60mm，均为巨大肿瘤。开始使用甲磺酸伊马替尼（伊马替尼）进行NAC。NAC的持续时间分别为6个月、11个月和12个月。术前CT显示的最大肿瘤直径小于NAC前，平均缩小率为23%。2例行腹腔镜经腹会阴联合切除术，1例行腹腔镜超低位前切除术及回肠造口术。无Clavien-Dindo分级Ⅱ级或更高的围手术期并发症。所有患者均为高危组，术后接受伊马替尼辅助化疗。目前，术后分别为2年3个月、1年2个月和1年，均存活且无复发。伊马替尼新辅助化疗有助于巨大直肠GIST的微创根治性手术。
