Qiu Hui, Wang Zhen, Liu Bonan, Sun Rongze, Tian Xiuyun, Hao Chunyi
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Hepato-Pancreato-Biliary Surgery, Sarcoma Center, Peking University Cancer Hospital and Institute, Beijing, China.
Intractable Rare Dis Res. 2024 Feb;13(1):51-56. doi: 10.5582/irdr.2023.01112.
To analyze the outcome in patients who have undergone multivisceral resection (MVR) for locally advanced gastrointestinal stromal tumors (GISTs), and identify the risk factors for tumor recurrence and postoperative morbidity. Sixty-four patients who operated for locally advanced GISTs with MVR in PPeking University Cancer Hospital Sarcoma Center (PUCHSC) between 2013 and 2021 were identified. Clinicopathologic characteristics, surgical outcomes, recurrence, and 5-year recurrence-free and overall survival were evaluated. The mean age of the patients was 60 years. Mean tumor size was 11.1 cm. Complete resection was achieved in all patients. The estimated 5-year recurrence-free and overall survival were 86.6% and 90.0%, respectively. Independent factor of recurrence following surgery was mitotic count on multivariate analysis. Overall postoperative morbidity was 53.1% ( = 34). Severe morbidity was 21.9% ( = 14). The most common severe complication was clinically relevant pancreatic fistula ( = 12, 18.8%), followed by anastomotic leakage ( = 4, 6.3%) and Intraabdominal abscess ( = 4, 6.3%). Multivariate analysis showed that preoperative imatinib therapy could reduce overall morbidity. Long operation time, combined colectomy and pancreatectomy were independent risk factors for postoperative severe morbidity. Compared to partial pancreatectomy, pancreaticoduodenectomy (PD) was significantly increased the incidence of severe morbidity. In conclusion, compared to systemic therapy alone, the outcome of locally advanced GISTs after MVR was more favorable. Despite the high overall morbidity, the postoperative severe morbidity and mortality of MVR were acceptable. Preoperative imatinib therapy should be recommended whenever possible. Combined pancreatectomy and colectomy are associated with significant postoperative severe morbidities. PD should be thoroughly discussed and be subject to MDT approach before surgery.
分析接受多脏器切除术（MVR）治疗局部晚期胃肠道间质瘤（GIST）患者的预后，并确定肿瘤复发和术后并发症的危险因素。确定了2013年至2021年期间在北京大学肿瘤医院肉瘤中心（PUCHSC）接受MVR手术治疗局部晚期GIST的64例患者。评估其临床病理特征、手术结果、复发情况以及5年无复发生存率和总生存率。患者的平均年龄为60岁。平均肿瘤大小为11.1厘米。所有患者均实现了完整切除。估计5年无复发生存率和总生存率分别为86.6%和90.0%。多因素分析显示，术后复发的独立因素是有丝分裂计数。总体术后并发症发生率为53.1%（n = 34）。严重并发症发生率为21.9%（n = 14）。最常见的严重并发症是具有临床意义的胰瘘（n = 12，18.8%），其次是吻合口漏（n = 4，6.3%）和腹腔内脓肿（n = 4，6.3%）。多因素分析表明，术前伊马替尼治疗可降低总体并发症发生率。手术时间长、联合结肠切除术和胰腺切除术是术后严重并发症的独立危险因素。与部分胰腺切除术相比，胰十二指肠切除术（PD）显著增加了严重并发症的发生率。总之，与单纯系统治疗相比，MVR术后局部晚期GIST的预后更有利。尽管总体并发症发生率较高，但MVR术后的严重并发症和死亡率是可以接受的。应尽可能推荐术前伊马替尼治疗。联合胰腺切除术和结肠切除术与显著的术后严重并发症相关。术前应充分讨论PD并采用多学科团队（MDT）方法。
