Surgical treatment for gastric GIST with special reference to liver metastases.
OBJECTIVE
Gastrointestinal stromal tumor (GIST) is recently defined as a tumor expressing c-kit and sometimes showing liver metastasis. We investigated the outcomes of gastric GIST with special attention to the effect of repeated treatment for the patients with liver metastases.


METHODS
Fourteen gastric GISTs were retrospectively reviewed and the significance of the NIH stratification system was examined.


RESULTS
Liver metastasis was found in 4 of the 14 patients with gastric GISTs. Three of the 4 patients had metachronous liver metastases and underwent repeated hepatectomies after the initial operation for gastric GIST. The other patient had a synchronous liver metastasis and underwent total gastrectomy and partial resection of the liver as the initial treatment. Two of the 4 patients have received treatments 6 times, including hepatic resection, microwave coagulation therapy (MCT), radiofrequency ablation (RFA), or by imatinib. All 4 patients with hepatic metastases are alive after the first hepatectomy with a mean survival time of 64.8 months with or without imatinib treatment. None classified to very low risk and low risk groups by the NIH system showed liver metastasis, while 43% of the patients classified to the high risk showed liver metastasis.


CONCLUSIONS
Repeated surgical and medical treatments for liver metastases from gastric GIST improve survival. Special attention should be paid to be the high risk group categorized by the NIH classification system.
Maehara
Naoki
N
Department of Surgery 1, Miyazaki University School of Medicine, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan.
Chijiiwa
Kazuo
K
Eto
Tadaaki
T
Funagayama
Mayumi
M
Uchiyama
Shuichiro
S
Nakashima
Shinya
S
Hidaka
Hideki
H
Hotokezaka
Masayuki
M
D000328:Adult; D000368:Aged; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000556:secondary* / Q000601:surgery*; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*