Robotic surgery for gastric gastrointestinal stromal tumors: A single center case series
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Abstract:
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.Keywords:
Single Center
Stromal tumor
Wedge resection
This article discusses multiple clinical trials using imatinib for the treatment of gastrointestinal stromal tumor (GIST). Specific topics include the risk associated with the interruption of imatinib therapy among advanced GIST patients, the link between higher doese of imatinib for GIST and longer progression-free survival, as well as the use of imatinib for recurrence-free survival in completely resected GIST.
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Objective To discuss the role of imatinib preoperative chemotherapy in treatment of advanced gastrointestinal stromal tumor(GIST). Method The related literatures about imatinib preoperative chemotherapy for GIST were reviewed. Results Imatinib preoperative chemotherapy is an effective treatment for advanced GIST, which signifi cantly improve the resection rate and prolong the overall survival time for patients with advanced GIST. Conclusions Preoperative imatinib treatment has good effect for metastatic or locally advanced GIST. It should be individualized by gene type of the GIST, which is deserved to be further studied.
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Gastrointestinal stromal tumor (GIST) is a rare neoplasm exhibiting, in most cases, mutations of c-kit. Recently it has been demonstrated that a majority of GIST patients with c-kit mutations respond to therapy with imatinib, a c-kit tyrosine kinase inhibitor. Although the response rate in patients treated with imatinib in prospective clinical studies is above 50%, complete response is rare, and the data on the use of imatinib as neoaduvant therapy facilitating radical surgery is still scanty. Here, we report on a patient with metastatic gastric GIST who underwent surgery after 6 months of imatinib therapy. No tumor cells were detected on pathological examination of resection specimen. This case report indicates that a pathological complete response could be achieved with imatinib therapy in patients with GIST, but a wider experience and longer follow-up is necessary to appreciate the prognostic significance of pathological complete response in GIST.
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Malignant gastrointestinal stromal tumours (GIST) have a poor prognosis. Since these tumours are resistant to conventional radiation and chemotherapy, surgery has been the mainstay of treatment. However, surgery is usually inadequate for the treatment of malignant GIST. Imatinib, a KIT tyrosine kinase inhibitor, has recently been found to have a dramatic antitumour effect on GIST. In this centre-based study of 17 consecutive patients with high-risk or overtly malignant GIST, imatinib was used in three different settings – palliatively, adjuvantly, and neoadjuvantly. The treatment was found to be safe and particularly effective in tumours with activating mutations of exon 11 of the KIT gene. Clinical response to imatinib treatment correlated morphologically to tumour necrosis, hyalinisation, and reduced proliferative activity. The value of neoadjuvant imatinib treatment was illustrated in one case.
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Molecular targeted agents changed the therapeutic pattern on gastrointestinal stromal tumor (GIST).Imatinib of 400 mg/d is recommended to be the first line therapy for metastatic GIST.Escalation of imatinib dose or sunitinib could improve the overall survival of patients when the treatment with standard dose of imatinib failed.In addition,new targeted agents showed potential anti-tumor efficacy.Imatinib adjuvant therapy could improve the recurrence-free survival of GIST patients with median or high risk after complete tumor resection.Preoperative treatment with imatinib raises tumor resection rate,but whether it could provide survival benefit has not been proved.C-kit/PDGFRα gene mutation can predict the efficacy of imatinib and sunitinib,and it is helpful to screen out the GIST patients to receive imatinib adjuvant therapy.
Key words:
Gastrointestinal stomal tumor; Molecular targeted therapy; Gene mutation
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Hintergrund: Die Einführung des Tyrosinkinase-Inhibitors Imatinib in die Behandlung von metastasierten gastrointestinalen Stromatumoren (GIST) ermöglichte erstmals eine effektive medikamentöse Therapie dieser Tumorentität. In dieser Arbeit präsentieren wir unsere Ergebnisse einer Langzeitbehandlung und vergleichen diese mit einer historischen Gruppe von GIST-Patienten, die bereits vor Einführung von Imatinib verstorben waren. Methoden: Vierzehn Patienten mit Rezidiv eines GIST oder metastasiertem GIST wurden mit Imatinib behandelt. Zehn Patienten aus der Zeit vor Einführung von Imatinib standen als Kontrollgruppe zur Verfügung. Zur Identifizierung chromosomaler Veränderungen, die als prädiktive Marker eines Therapieansprechens dienen könnten, wurde eine Comparative genomic hybridization (CGH) der Tumoren durchgeführt. Ergebnisse: Die mittlere Behandlungsdauer der Imatinib-Gruppe betrug 22,3 Monate. Hierbei hatten 1 Patient ein primäres Therapieversagen, 2 Patienten einen Progress nach anfänglichem Therapieansprechen, 2 Patienten eine stabile Tumorerkrankung, 8 Patienten ein partielles Ansprechen und 1 Patient eine komplette Remission. Die Nebenwirkungen waren insgesamt gering. Das Überleben war bereits jetzt in der Gruppe der behandelten Patienten höher (41.1 vs. 34,8 Monate in der historischen Gruppe). Von den behandelten Patienten leben zum gegenwärtigen Zeitpunkt 11 Patienten. Bei der CGH-Analyse fand sich eine ähnliche Anzahl chromosomaler Aberrationen bei beiden Patientengruppen. Schlussfolgerungen: Die längerfristige Behandlung mit Imatinib bei Patienten mit metastasierten oder rezidivierten GIST ist sicher und wirkt lebensverlängernd.
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