title: Surgical second-look in high risk gastrointestinal stromal tumor of small intestine: A case report.
abstract: BACKGROUND
  The peritoneum is one of the most common sites of distant gastrointestinal stromal tumor (GIST) metastases. In particular, GIST arising from the small intestine with resected minimal synchronous macroscopic peritoneal carcinomatosis or with primary tumor rupture has a higher risk of developing peritoneal recurrence. Current clinical practice does not envisage second-look surgery in GIST patients at high risk of developing peritoneal recurrence, and no literature data are available.
  
  
  METHODS
  We describe a 45-year-old woman who underwent emergency surgical resection of jejunal GIST presenting with spontaneous tumor rupture, synchronous ovarian and minimal macroscopic peritoneal involvement, and subsequent second-look surgery after 13 months of imatinib treatment.
  
  
  CONCLUSIONS
  Second-look surgery confirmed a 2.6cm lesion close to the mesenteric border of the fourth jejunal loop, and 11 peritoneal lesions with a macroscopic necrotic aspect related to treatment response. After conversion to an open procedure, a segmental jejunal resection was performed with removal of all peritoneal lesions and macroscopic radical cytoreduction.
  
  
  CONCLUSIONS
  Second-look surgery in selected GIST patients may be performed after at least 12 months of medical treatment with tyrosine-kinase inhibitors to identify those patients with limited peritoneal disease not disclosed by instrumental imaging who could undergo radical cytoreduction of peritoneal lesions.
authors.affiliation: Department of Hematology and Oncology Sciences "L.A. Seragnoli", S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. Electronic address: maggie.nannini@gmail.com.
authors.forename: Margherita
authors.initials: M
authors.lastname: Nannini
authors.forename: Maria Abbondanza
authors.initials: MA
authors.lastname: Pantaleo
authors.forename: Fausto
authors.initials: F
authors.lastname: Catena
authors.forename: Stefania
authors.initials: S
authors.lastname: Romano
authors.forename: Salvatore
authors.initials: S
authors.lastname: Tondo
authors.forename: Maria Giulia
authors.initials: MG
authors.lastname: Pirini
authors.forename: Cristian
authors.initials: C
authors.lastname: Lolli
authors.forename: Alessandra
authors.initials: A
authors.lastname: Maleddu
authors.forename: Anna
authors.initials: A
authors.lastname: Mandrioli
authors.forename: Lidia
authors.initials: L
authors.lastname: Gatto
authors.forename: Maristella
authors.initials: M
authors.lastname: Saponara
authors.forename: Maria Caterina
authors.initials: MC
authors.lastname: Pallotti
authors.forename: Angelo Paolo
authors.initials: AP
authors.lastname: Dei Tos
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
authors.forename: Guido
authors.initials: G
authors.lastname: Biasco