title: Laparoscopic sphincter-preserving surgery (intersphincteric resection) after neoadjuvant imatinib treatment for gastrointestinal stromal tumor (GIST) of the rectum.
abstract: BACKGROUND
  Gastrointestinal stromal tumors (GISTs) of the rectum are rarely found, and radical surgery such as abdominoperineal resection would be necessary for large rectal GIST. On the other hand, therapy for GIST has changed significantly with the use of imatinib. Neoadjuvant imatinib therapy may reduce tumor size and may potentially prevent extended surgery. Moreover, when sphincter-preserving surgery is carried out laparoscopically, it can be performed as minimally invasive surgery with preservation of the anus.
  
  
  METHODS
  From 2008 to 2011, five patients with rectal GIST were treated in our hospital. All patients received preoperative imatinib treatment (400 mg/day) and underwent laparoscopic sphincter-preserving surgery after 4-12 months of this treatment.
  
  
  RESULTS
  Initial median tumor size was 31 mm (range, 24-88). At the time of operation, the median tumor size was 24 mm (range, 11-52). Sphincter-preserving surgery was performed in all patients. Three patients underwent laparoscopic intersphincteric resection (ISR), and two patients underwent transanal full-thickness local resection and recto-anal anastomosis following laparoscopic ISR. Macroscopically complete resection was achieved, and microscopically, the resection margin was not involved of residual tumors. The median duration of postoperative hospital stay was 16 days (range, 13-30). No recurrence occurred in all patients during 1 to 4 years.
  
  
  CONCLUSIONS
  The present study suggests that neoadjuvant imatinib therapy might be effective to prevent extended surgery for rectal GIST, and laparoscopic sphincter-preserving surgery is safe and technically feasible. We recommend a combination of neoadjuvant imatinib therapy and laparoscopic ISR for locally advanced rectal GIST.
authors.affiliation: Department of Gastroenterological Surgery, Cancer Institute Hospital, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan, yoshiya.fujimoto@jfcr.or.jp.
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Fujimoto
authors.forename: Takashi
authors.initials: T
authors.lastname: Akiyoshi
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Konishi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nagayama
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Fukunaga
authors.forename: Masashi
authors.initials: M
authors.lastname: Ueno
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000601:surgery*; D001549:Benzamides / Q000627:therapeutic use*; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D000068877:Imatinib Mesylate; D010535:Laparoscopy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D059351:Organ Sparing Treatments; D010879:Piperazines / Q000627:therapeutic use*; D011743:Pyrimidines / Q000627:therapeutic use*; D011859:Radiography; D012007:Rectum / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate
references.citation: Ann Surg Oncol. 2007 Feb;14(2):526-32
references.pmid: 17139461
references.citation: Cancer. 2008 Feb 1;112(3):608-15
references.pmid: 18076015
references.citation: Surg Endosc. 2008 Feb;22(2):557-61
references.pmid: 18193475
references.citation: Am J Clin Oncol. 2011 Jun;34(3):314-6
references.pmid: 20622646
references.citation: Surg Today. 2008;38(2):174-7
references.pmid: 18239881
references.citation: Gut. 2006 Apr;55(4):585-6
references.pmid: 16531543
references.citation: Colorectal Dis. 2011 Oct;13(10):1110-5
references.pmid: 21040362
references.citation: World J Gastroenterol. 2009 Apr 21;15(15):1910-3
references.pmid: 19370794
references.citation: Ann Surg. 2000 Jan;231(1):51-8
references.pmid: 10636102
references.citation: Ann Oncol. 2005 Apr;16(4):566-78
references.pmid: 15781488
references.citation: N Engl J Med. 2001 Apr 5;344(14):1052-6
references.pmid: 11287975
references.citation: Eur J Surg Oncol. 2009 Jul;35(7):739-45
references.pmid: 19110398
references.citation: Ann Surg. 2007 Mar;245(3):341-6
references.pmid: 17435538
references.citation: J Natl Compr Canc Netw. 2007 Jul;5 Suppl 2:S1-29; quiz S30
references.pmid: 17624289
references.citation: Ann Oncol. 2008 May;19 Suppl 2:ii35-8
references.pmid: 18456761
references.citation: Lancet. 2004 Sep 25-Oct 1;364(9440):1127-34
references.pmid: 15451219
references.citation: J Surg Oncol. 2009 Jan 1;99(1):42-7
references.pmid: 18942073
references.citation: Surg Today. 2012 Nov;42(11):1096-9
references.pmid: 22294424
references.citation: J Gastrointest Surg. 2010 Apr;14(4):645-50
references.pmid: 20094813
references.citation: N Engl J Med. 2002 Aug 15;347(7):472-80
references.pmid: 12181401
references.citation: Dis Colon Rectum. 2005 Jun;48(6):1316-9
references.pmid: 15793646
references.citation: Am J Gastroenterol. 2005 Jan;100(1):162-8
references.pmid: 15654796