title: Esophageal gastrointestinal stromal tumor: is tumoral enucleation a viable therapeutic option?
abstract: OBJECTIVE
  The primary objective was to evaluate the feasibility of surgical enucleation of esophageal gastrointestinal stromal tumors (E-GISTs). Secondary objectives evaluated (i) the impact of tumor enucleation on oncological outcomes, (ii) the effect of pretherapeutic biopsy on the feasibility of E-GIST enucleation, and (iii) the impact of mucosal ulceration on outcome.
  
  
  BACKGROUND
  E-GISTs are very rare tumors and esophageal resection has been the recommended approach. The feasibility and impact on outcomes of tumor enucleation are unknown.
  
  
  METHODS
  Through a large national multicenter retrospective study, 19 patients with E-GISTs were identified between 2001 and 2010. Patients who underwent either enucleation or esophagectomy were compared.
  
  
  RESULTS
  Of over 19 patients identified with E-GISTs, curative treatment was surgical for 16 patients, with enucleation in 8 and esophagectomy in 8. In the enucleation group, median tumoral diameter was 40 mm (18-65 mm), without any mucosal ulceration, preoperative capsular ruptures, or incomplete resections. In the esophagectomy group, the median tumoral diameter was 85 mm (55-250 mm), with mucosal ulceration in 4 patients, preoperative capsular rupture in 1, and no incomplete resections. Severe postoperative complication rates were 50% and 25% in the esophagectomy and enucleation groups, respectively, with 2 postoperative deaths after esophagectomy. After a median follow-up of 6.4 years, 2 recurrences were observed after esophagectomy versus 0 after enucleation. Endoscopic biopsies did not expose patients to complications or local recurrence after enucleation. Endoscopic mucosal ulceration was associated with more aggressive tumors.
  
  
  CONCLUSIONS
  E-GIST enucleation seems safe for tumors of less than 65 mm in diameter.
authors: *Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Lille, France †North of France University, Lille, France ‡Integrated Research Center in Oncology: SIRIC ONCOLille, Lille, France §Inserm, UMR837, Jean-Pierre Aubert Research Center, Team 5 Mucins, Epithelial Differentiation and Carcinogenesis, Lille, France ¶University Hospital Croix-Rousse, Lyon, France ∥Institut Mutualiste Montsouris, Paris, France.
authors: W B
authors: WB
authors: Robb
authors: E
authors: E
authors: Bruyere
authors: D
authors: D
authors: Amielh
authors: E
authors: E
authors: Vinatier
authors: J Y
authors: JY
authors: Mabrut
authors: T
authors: T
authors: Perniceni
authors: G
authors: G
authors: Piessen
authors: Christophe
authors: C
authors: Mariette
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D046152:Gastrointestinal Stromal Tumors / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014456:Ulcer / Q000473:pathology; D055815:Young Adult