Gastrointestinal stromal tumor (GIST)'s surgical treatment, NCI experience.
OBJECTIVE
To review the clinical presentation, surgical management, and prognostic factors for gastrointestinal stromal tumors.


METHODS
A prospective study which was carried out between January 2002 and March 2004 on thirty-three patients with gastrointestinal stromal tumor (GIST) at the National Cancer Institute, Cairo University. All patients were evaluated preoperatively and underwent exploratory laparotomy with a curative intent, they were followed up for period ranging between 14-35 months.


RESULTS
Among the 33 patients there were 17 males and 16 females. The mean age of patients was 52.8 years. Clinical findings included gastrointestinal bleeding (42.4%), palpable mass (33.3%) and abdominal pain (24.3%). The stomach was the most common site of origin of the disease (39.4%), followed by the colorectal region (24.2%). Tumors were high grade in 63.6% of patients and low-grade in 36.4% of patients. Complete resection of all gross disease was accomplished in 26 patients (78.7%), among whom, multiple adjacent organ resection was required in 6 patients (22.2 %) and metastatic disease was identified in the liver in 3 patients at the time of exploratory surgery of these one could be resected. Immunohistochemical staining for CD117 was positive in 88.9% of patients. The median follow-up period was 20 months (range, 14-35 months). The overall median survival in this study was 25 months, and the cumulative survival at 30 months was 46.9%. Unfavorable prognostic factors were incomplete resection and, high-grade histological features (p<0.05). None of the patients received adjuvant or palliative chemotherapy. Twenty six patients (78.8%) are alive free of disease. Of the 7 patients with incomplete resections or biopsy only; 4 patients (12.1%) are alive with disease and 3 patients died.


CONCLUSIONS
Surgical resection, including en bloc resection of locally advanced tumors, remains the only curative treatment. Overall survival is significantly affected by high-grade tumors and positive resection margin.
El-Zohairy
Mohamad
M
The Department of Surgical Oncology, National Cancer Institute, Cairo University.
Khalil
El-Sayed Ashraf
el-SA
Fakhr
Ibrahim
I
El-Shahawy
Magdy
M
Gouda
Iman
I
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate