title: Laparoscopic resection of a gastrointestinal stromal tumor of the lower rectum in a patient with coronary artery disease following long-term neoadjuvant imatinib treatment and anticoagulation therapy.
abstract: Surgery is the mainstay of treatment for gastrointestinal stromal tumors (GISTs). However, complete resection of rectal GISTs is sometimes difficult because of bulkiness and/or anatomical reasons. Neoadjuvant imatinib therapy has gained attention as an alternative treatment to increase the chance of en bloc resection of rectal GISTs, although it usually takes several months. In this case report, we first demonstrated that neoadjuvant imatinib therapy can be performed safely not only to downsize tumors, but also to allow adequate time for the effective treatment of major comorbid illnesses. A 74-year-old man was diagnosed with a 45 mm GIST of the lower rectum. He also had severe stenosis in the proximal segment of the left anterior descending coronary artery. Following the implantation of a drug-eluting stent, the patient received imatinib together with dual anti-platelet therapy for 12 months without obvious side effects. Follow-up image studies revealed tumor shrinkage as well as stent patency. En bloc resection of the GIST was performed laparoscopically, which preserved the anus. The patient is currently alive without any evidence of relapse for 12 months after surgery.
authors.affiliation: Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. hiroanozawa-gi@umin.ac.jp.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nozawa
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Kanazawa
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Tanaka
authors.forename: Masao
authors.initials: M
authors.lastname: Takahashi
authors.forename: Soichiro
authors.initials: S
authors.lastname: Ishihara
authors.forename: Eiji
authors.initials: E
authors.lastname: Sunami
authors.forename: Joji
authors.initials: J
authors.lastname: Kitayama
authors.forename: Masako
authors.initials: M
authors.lastname: Ikemura
authors.forename: Issei
authors.initials: I
authors.lastname: Komuro
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Watanabe
mesh_terms: D000368:Aged; D001003:Anal Canal; D000925:Anticoagulants / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001549:Benzamides / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003324:Coronary Artery Disease / Q000150:complications*; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D046152:Gastrointestinal Stromal Tumors / Q000188:drug therapy / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D000068877:Imatinib Mesylate; D010535:Laparoscopy; D008297:Male; D020360:Neoadjuvant Therapy; D059351:Organ Sparing Treatments; D010879:Piperazines / Q000627:therapeutic use*; D011743:Pyrimidines / Q000627:therapeutic use*; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate