W B Robb1, E Bruyere, D Amielh, E Vinatier, J Y Mabrut, T Perniceni, G Piessen, Christophe Mariette. 1. *Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Lille, France †North of France University, Lille, France ‡Integrated Research Center in Oncology: SIRIC ONCOLille, Lille, France §Inserm, UMR837, Jean-Pierre Aubert Research Center, Team 5 Mucins, Epithelial Differentiation and Carcinogenesis, Lille, France ¶University Hospital Croix-Rousse, Lyon, France ∥Institut Mutualiste Montsouris, Paris, France.
Abstract
OBJECTIVE: The primary objective was to evaluate the feasibility of surgical enucleation of esophageal gastrointestinal stromal tumors (E-GISTs). Secondary objectives evaluated (i) the impact of tumor enucleation on oncological outcomes, (ii) the effect of pretherapeutic biopsy on the feasibility of E-GIST enucleation, and (iii) the impact of mucosal ulceration on outcome. BACKGROUND: E-GISTs are very rare tumors and esophageal resection has been the recommended approach. The feasibility and impact on outcomes of tumor enucleation are unknown. METHODS: Through a large national multicenter retrospective study, 19 patients with E-GISTs were identified between 2001 and 2010. Patients who underwent either enucleation or esophagectomy were compared. RESULTS: Of over 19 patients identified with E-GISTs, curative treatment was surgical for 16 patients, with enucleation in 8 and esophagectomy in 8. In the enucleation group, median tumoral diameter was 40 mm (18-65 mm), without any mucosal ulceration, preoperative capsular ruptures, or incomplete resections. In the esophagectomy group, the median tumoral diameter was 85 mm (55-250 mm), with mucosal ulceration in 4 patients, preoperative capsular rupture in 1, and no incomplete resections. Severe postoperative complication rates were 50% and 25% in the esophagectomy and enucleation groups, respectively, with 2 postoperative deaths after esophagectomy. After a median follow-up of 6.4 years, 2 recurrences were observed after esophagectomy versus 0 after enucleation. Endoscopic biopsies did not expose patients to complications or local recurrence after enucleation. Endoscopic mucosal ulceration was associated with more aggressive tumors. CONCLUSIONS: E-GIST enucleation seems safe for tumors of less than 65 mm in diameter.
OBJECTIVE: The primary objective was to evaluate the feasibility of surgical enucleation of esophageal gastrointestinal stromal tumors (E-GISTs). Secondary objectives evaluated (i) the impact of tumor enucleation on oncological outcomes, (ii) the effect of pretherapeutic biopsy on the feasibility of E-GIST enucleation, and (iii) the impact of mucosal ulceration on outcome. BACKGROUND: E-GISTs are very rare tumors and esophageal resection has been the recommended approach. The feasibility and impact on outcomes of tumor enucleation are unknown. METHODS: Through a large national multicenter retrospective study, 19 patients with E-GISTs were identified between 2001 and 2010. Patients who underwent either enucleation or esophagectomy were compared. RESULTS: Of over 19 patients identified with E-GISTs, curative treatment was surgical for 16 patients, with enucleation in 8 and esophagectomy in 8. In the enucleation group, median tumoral diameter was 40 mm (18-65 mm), without any mucosal ulceration, preoperative capsular ruptures, or incomplete resections. In the esophagectomy group, the median tumoral diameter was 85 mm (55-250 mm), with mucosal ulceration in 4 patients, preoperative capsular rupture in 1, and no incomplete resections. Severe postoperative complication rates were 50% and 25% in the esophagectomy and enucleation groups, respectively, with 2 postoperative deaths after esophagectomy. After a median follow-up of 6.4 years, 2 recurrences were observed after esophagectomy versus 0 after enucleation. Endoscopic biopsies did not expose patients to complications or local recurrence after enucleation. Endoscopic mucosal ulceration was associated with more aggressive tumors. CONCLUSIONS: E-GIST enucleation seems safe for tumors of less than 65 mm in diameter.
Authors: Andrew M Briggler; Rondell P Graham; Gustavo F Westin; Andrew L Folpe; Dawn E Jaroszewski; Scott H Okuno; Thorvardur R Halfdanarson Journal: J Gastrointest Oncol Date: 2018-08
Authors: Kyriakos Neofytou; Mafalda Costa Neves; Alexandros Giakoustidis; Charlotte Benson; Satvinder Mudan Journal: Case Rep Oncol Med Date: 2015-05-05
Authors: Juan Manuel Sanchez-Hidalgo; Manuel Duran-Martinez; Rafael Molero-Payan; Sebastian Rufian-Peña; Alvaro Arjona-Sanchez; Angela Casado-Adam; Antonio Cosano-Alvarez; Javier Briceño-Delgado Journal: World J Gastroenterol Date: 2018-05-14 Impact factor: 5.742