title: Trans-sacral (Kraske) approach for gastrointestinal stromal tumour of the lower rectum: old procedure for a new disease.
abstract: Gastrointestinal stromal tumours (GISTs) of the lower rectum are rare cancers from mesenchymatous origin, which are characterized by; 1) the absence of metastases in loco-regional lymph nodes; and 2) a tendency to grow opposite to the intestinal lumen. Thus, the two preferred surgical approaches for rectal adenocarcinomas (i.e. abdominal and transanal) are inappropriate for GISTs, due to: 1) the uselessness of total mesorectal excision; and 2) to the difficulty to locate the tumour with a transanal approach. We report here a case of a large GIST of the lower rectum which was successfully treated with a posterior trans-sacral approach. Lower rectum GISTs are good indications for the Kraske procedure, and this relatively new disease entity may contribute to the reintroduction of an old procedure into the armamentarium of 21(st) century colorectal surgeons.
authors.affiliation: Department of Surgery, University Hospital Geneva, Geneva, Switzerland. pascal.gervaz@hcuge.ch
authors.forename: P
authors.initials: P
authors.lastname: Gervaz
authors.forename: O
authors.initials: O
authors.lastname: Huber
authors.forename: P
authors.initials: P
authors.lastname: Bucher
authors.forename: P
authors.initials: P
authors.lastname: Sappino
authors.forename: P
authors.initials: P
authors.lastname: Morel
mesh_terms: D013505:Digestive System Surgical Procedures / Q000379:methods*; D046152:Gastrointestinal Stromal Tumors / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed