Mesenchymal tumors of the gastrointestinal tract include gastrointestinal stromal tumors (GIST) and other rare gastrointestinal sarcomas. In this chapter, we comprehensively reviewed the most important epidemiologic, pathologic, and clinic characteristics of the mesenchymal tumors of the gastroinsteinal tract, with a particular focus on GIST. Therapeutically relevant insights on the molecular biology of GIST are also included. Gastrointestinal sarcomas other than GIST are exceedingly rare and limited information on their natural history and management is available.[Aspects of disease affecting the small bowel are covered in Chapter Unavailable ].
The aim of surgical treatment of gastrointestinal stromal tumors (GIST) is a microscopically complete resection. Initial indications for laparoscopic surgery were limited to smaller tumors, in favorable locations. Over time, indications for minimal invasive surgery (MIS) have expanded, however concerns remain when considering resection of larger GISTs. Our aims were to assess the utility of robotic resection of gastric GISTs for challenging tumors.GIST resections, in this study were performed using the Intuitive Da Vinci Surgical Xi System. GIST's were considered challenging if tumor size was >50 mm at the time of surgery and/or the location of the tumor was type II, III, or IV using Privette/Al-Thanai classification.Robotic resections were performed on 12 consecutive patients, 83% were considered challenging cases, 6 out of 12 for location and 5 out of 12 for size. Initial median tumor size on imaging was 53.7 mm, and post-imatinib was 45.8 mm. All tumors were removed with clear margins (R0) via wedge resections, with no complications. Median operative time was 192 minutes (95-250). Length of hospital stay was 2 days (2-6).Robotic resection of gastric GIST's appears oncologically safe, and may expand the benefits of MIS to a greater cohort of complex cases.
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