title: Surgical management of small gastrointestinal stromal tumors of the stomach.
abstract: Small gastrointestinal stromal tumors (GISTs) (< 3 cm) occasionally are found in the stomach during endoscopy. There is no consensus about the surgical management of these small tumors, although this clinical issue is crucial because some of the tumors show unexpected malignant behavior. In this study, we evaluated the clinical management of patients with gastric GISTs who underwent surgical resection. Altogether, 31 patients with gastric GISTs were examined retrospectively. Surgical resection was fundamentally indicated for the patients with gastric GISTs suspected to be malignant by endoscopy or endoscopic ultrasonography (EUS). The malignant grade of the GISTs was evaluated by the mitotic rate, tumor size, and MIB-1 index. EUS was useful for differentiating benign from malignant GISTs; but by limiting the study to patients with small tumors (< 3 cm), the diagnostic value of EUS was not satisfactory for defining the surgical indication. Tumors that were < 50 mm were successfully treated by laparoscopic surgery. Of the 31 patients, 4 had a relapse of the disease, and 1 of those 4 patients had a small tumor (30 mm). All of the recurrences were classified in the high risk category. Surgery is indicated for gastric GISTs that are > or = 20 mm or are suspected to be malignant based on EUS findings. Laparoscopic resection is feasible and is recommended as the treatment of choice for patients with tumors < 50 mm. Risk assessment can be most useful for predicting recurrence.
authors.affiliation: Second Department of Surgery, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Iwahashi
authors.forename: Katsunari
authors.initials: K
authors.lastname: Takifuji
authors.forename: Toshiyasu
authors.initials: T
authors.lastname: Ojima
authors.forename: Masaki
authors.initials: M
authors.lastname: Nakamura
authors.forename: Mikihito
authors.initials: M
authors.lastname: Nakamori
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Nakatani
authors.forename: Kentaro
authors.initials: K
authors.lastname: Ueda
authors.forename: Koichiro
authors.initials: K
authors.lastname: Ishida
authors.forename: Teiji
authors.initials: T
authors.lastname: Naka
authors.forename: Kazuo
authors.initials: K
authors.lastname: Ono
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamaue
mesh_terms: D000368:Aged; D019160:Endosonography; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*