title: Long-term outcomes and recurrence patterns in upper gastrointestinal tract gastrointestinal stromal tumours (GISTs) treated by minimally invasive surgery.
abstract: OBJECTIVE
  Gastrointestinal stromal tumours are the most frequently occurring sarcoma of the gastrointestinal tract. Current treatment involves complete resection although the surgical or pathological margin required remains unclear. In this study we aimed to examine the risk of local and distant recurrence following laparoscopic resection.
  
  
  METHODS
  From a prospective tumour database, we identified and risk stratified primary non-metastatic tumours treated by laparoscopic resection from 2002-2012. Local technique involves allowing a 1 cm margin for resection. We then identified all cases of tumour recurrence and tumour related death in order to calculate overall survival, freedom from GIST recurrence and disease-specific survival respectively.
  
  
  RESULTS
  90 patients were identified with a median follow-up of 3.9 years (range 1 week to 12.3 years). Five-year freedom from GIST recurrence and disease-specific survival rates in the high-risk group stood at 0.63 and 0.90. In the moderate-risk group these figures stood at 0.61 and 0.80 respectively. The low- and very-low-risk groups had a 10-year recurrence-free survival of 100% with no incidences of tumour-related recurrence. There were no local recurrences seen in any group at up to 10 years.
  
  
  CONCLUSIONS
  The low recurrence rate suggests that these tumours can safely be treated laparoscopically with an R0 resection using a macroscopic surgical margin of 10 mm. Disease-specific survival was high. This may reflect earlier detection and the use of adjuvant imatinib.
authors.affiliation: Norwich Medical School, Norfolk and Norwich University Hospital, Norwich, UK.
authors.forename: Evangelos S
authors.initials: ES
authors.lastname: Photi
authors.forename: Laszlo
authors.initials: L
authors.lastname: Igali
authors.forename: Edward C K
authors.initials: EC
authors.lastname: Cheong
authors.forename: Allan
authors.initials: A
authors.lastname: Clark
authors.forename: Michael P N
authors.initials: MP
authors.lastname: Lewis
mesh_terms: D000368:Aged; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005770:Gastrointestinal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D046152:Gastrointestinal Stromal Tumors / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom; D041742:Upper Gastrointestinal Tract / Q000473:pathology