Laparoscopic management of acutely presenting gastrointestinal stromal tumors: a study of 9 cases and review of literature.

INTRODUCTION: Gastrointestinal stromal tumors (GISTs) are rare. Nevertheless, some may present with a life-threatening hemorrhage or intestinal obstruction. The aim of this study was to review the various modes of the presentation of GIST, especially hemorrhage and obstruction, and to assess the role of laparoscopic surgery in the management of acute cases and the correlation of such cases with malignant potential.
METHODS: Data were collected from the hospital in the patient records as well as a prospective database. Their presentation, management, histologic features, and follow-up periods were analyzed.
RESULTS: Nine cases of GIST were collected. Five (56%) presented with hemorrhage, 3 (33%) with intestinal obstruction, and 1 (11%) with a tender epigastric mass. Six patients had a gastroscopy procedure, and 6 had a computed tomography scan of the abdomen and pelvis. Five (67%) patients underwent a partial gastrectomy (3 laparoscopic and 2 open procedures), 1 had a laparoscopic localized resection of a gastric GIST, and 3 (33%) had a resection and anastomosis of the bowel. All patients presented acutely, and 78% had emergency surgery performed. The laparoscopic approach was attempted in 6 patients (67%), and was successful in 4 (67%). All patients who had a laparoscopic treatment performed had less pain, a quicker recovery, and a shorter hospital stay, as compared to those patients who had open surgery. Five cases were malignant tumors. Immunohistochemistry revealed a positive c-kit and CD34 for all tumors. The median follow-up was 24 months with one recurrence.
CONCLUSIONS: Our experience showed that GISTs can present acutely and may need immediate surgical intervention. A laparoscopic treatment is safe and practical in experienced hands. Tumor size and hemorrhage at presentation can predict a patient's malignant potential.