title: Surgical management of gastrointestinal stromal tumors: a single center experience.
abstract: BACKGROUND
  Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal (GI) tract. Although the therapy targeted at inhibiting tyrosine kinases has shown dramatic results in metastatic and inoperable GISTs, the mainstay of treatment in primary localized forms remains surgical resection.
  
  
  OBJECTIVE
  To provide an overview of our experience of GIST diagnosis and management, with emphasis on comparison of minimally invasive and open surgical resection for primary GISTs.
  
  
  METHODS
  We retrospectively reviewed the medical records of all patients who underwent surgical removal of GISTs from 2008 to 2012. Patient demographics, clinical data, surgery, complications, histopathological data and clinical course were analyzed.
  
  
  RESULTS
  Forty-four patients were identified. Average age at diagnosis was 63 years. Minimally invasive (MIS) and open surgery (OS) were each attempted in 22 (50.0%) patients. Laparoscopic removal was performed in 20, laparoendoscopic in 1, and laparoscopy-assisted endoscopic removal in 1. Conversion to an open procedure was performed in 4 (18.2%). We found significant differences in postoperative length of stay (8.5 days vs. 10.1 days, p < 0.001) and tumor size (2.93 cm vs. 5.78 cm, p = 0.018) between MIS and OS groups, respectively.
  
  
  CONCLUSIONS
  Laparoscopic removal is safe and effective for GISTs not exceeding 6 cm. Gastroesophageal junction and cardia GISTs require careful preoperative evaluation and planning to remove safely. We recommend avoiding laparoscopic removal of these tumors due to the high rate of conversion (100.0%) to an open procedure. Laparoendoscopic surgical approach is an appropriate technique for removal of small-sized intraluminal benign GISTs not involving the muscularis propria layer.
authors.affiliation: Clinic of Gastroenterology, Nephrourology and Surgery, Center of Abdominal Surgery, Vilnius University, Faculty of Medicine, Vilnius, Lithuania.
authors.forename: Eligijus
authors.initials: E
authors.lastname: Poškus
authors.affiliation: Clinic of Gastroenterology, Nephrourology and Surgery, Center of Abdominal Surgery, Vilnius University, Faculty of Medicine, Vilnius, Lithuania.
authors.forename: Pavel
authors.initials: P
authors.lastname: Petrik
authors.affiliation: Department of Physiology, Biochemistry and Laboratory Medicine, Vilnius University, Faculty of Medicine, Vilnius, Lithuania.
authors.forename: Eglė
authors.initials: E
authors.lastname: Petrik
authors.affiliation: Clinic of Gastroenterology, Nephrourology and Surgery, Center of Abdominal Surgery, Vilnius University, Faculty of Medicine, Vilnius, Lithuania.
authors.forename: Vytautas
authors.initials: V
authors.lastname: Lipnickas
authors.affiliation: Clinic of Gastroenterology, Nephrourology and Surgery, Center of Abdominal Surgery, Vilnius University, Faculty of Medicine, Vilnius, Lithuania.
authors.forename: Juozas
authors.initials: J
authors.lastname: Stanaitis
authors.affiliation: Clinic of Gastroenterology, Nephrourology and Surgery, Center of Abdominal Surgery, Vilnius University, Faculty of Medicine, Vilnius, Lithuania.
authors.forename: Kęstutis
authors.initials: K
authors.lastname: Strupas
keywords: gastrointestinal stromal tumors; minimally invasive surgery
references.citation: Wideochir Inne Tech Maloinwazyjne. 2011 Sep;6(3):138-43
references.pmid: 23255972
references.citation: J Surg Oncol. 2008 Dec 15;98(8):588-93
references.pmid: 19072850
references.citation: Cancer. 2005 Feb 15;103(4):821-9
references.pmid: 15648083
references.citation: World J Gastroenterol. 2008 Apr 28;14(16):2609-11
references.pmid: 18442217
references.citation: Ann Surg. 2006 Aug;244(2):176-84
references.pmid: 16858179
references.citation: Ann Surg. 2006 Jun;243(6):738-45; discussion 745-7
references.pmid: 16772777
references.citation: N Engl J Med. 2001 Apr 5;344(14):1052-6
references.pmid: 11287975
references.citation: Wideochir Inne Tech Maloinwazyjne. 2013 Sep;8(3):249-52
references.pmid: 24130642
references.citation: Ann Oncol. 2008 May;19 Suppl 2:ii35-8
references.pmid: 18456761
references.citation: J Surg Oncol. 2005 Jun 1;90(3):195-207; discussion 207
references.pmid: 15895440
references.citation: Surg Endosc. 2008 Dec;22(12):2583-7
references.pmid: 18322738
references.citation: J Surg Oncol. 2008 Oct 1;98(5):384-92
references.pmid: 18668671
references.citation: Surg Endosc. 1997 Mar;11(3):287-9
references.pmid: 9079613
references.citation: Surg Endosc. 2008 Jul;22(7):1729-35
references.pmid: 18074180
references.citation: Cancer Res. 2001 Nov 15;61(22):8118-21
references.pmid: 11719439
references.citation: Ann Surg. 2008 Jun;247(6):1011-8
references.pmid: 18520229
references.citation: J Am Coll Surg. 2009 Jan;208(1):80-6
references.pmid: 19228508
references.citation: Gastrointest Endosc. 2009 Aug;70(2):254-61
references.pmid: 19482280
references.citation: Dig Dis Sci. 2007 Sep;52(9):2249-53
references.pmid: 17420941
references.citation: Surg Endosc. 2012 Dec;26(12):3509-14
references.pmid: 22684977
references.citation: Surg Endosc. 2007 Oct;21(10):1685-9
references.pmid: 17661137
references.citation: World J Gastroenterol. 2012 Dec 14;18(46):6720-8
references.pmid: 23239909
references.citation: Ann Surg Oncol. 2002 Nov;9(9):831-9
references.pmid: 12417503
references.citation: Hum Pathol. 2002 May;33(5):459-65
references.pmid: 12094370
references.citation: Nat Rev Gastroenterol Hepatol. 2009 Jun;6(6):363-71
references.pmid: 19365407
references.citation: Surg Endosc. 2006 May;20(5):713-6
references.pmid: 16502196
references.citation: JSLS. 2009 Apr-Jun;13(2):165-9
references.pmid: 19660210
references.citation: Arch Pathol Lab Med. 2006 Oct;130(10):1466-78
references.pmid: 17090188
references.citation: World J Surg. 2008 Jun;32(6):1021-8
references.pmid: 18338207
references.citation: J Clin Oncol. 2004 Sep 15;22(18):3813-25
references.pmid: 15365079
references.citation: Am J Surg Pathol. 2005 Jan;29(1):52-68
references.pmid: 15613856
references.citation: Am J Gastroenterol. 2005 Jan;100(1):162-8
references.pmid: 15654796
references.citation: JSLS. 2011 Apr-Jun;15(2):228-31
references.pmid: 21902981
references.citation: J Natl Compr Canc Netw. 2007 Jul;5 Suppl 2:S1-29; quiz S30
references.pmid: 17624289
references.citation: J Gastroenterol. 2005 Aug;40(8):775-80
references.pmid: 16143881
references.citation: Br J Surg. 2009 Jun;96(6):567-78
references.pmid: 19434705