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  • Title: Is multivisceral resection in locally advanced gastrointestinal stromal tumours an acceptable strategy?
    Author: Wong JSM, Tan GHC, Quek R, Goh BKP, Kwok LL, Kumar M, Soo KC, Teo MCC.
    Journal: ANZ J Surg; 2017 Jun; 87(6):477-482. PubMed ID: 27226158.
    Abstract:
    BACKGROUND: Gastrointestinal stromal tumours (GISTs) represent the most common mesenchymal tumour of the gastrointestinal tract. Although the efficacy of targeted therapy cannot be over-emphasized, surgery remains the only curative primary treatment for patients with localized disease. The median size of GIST at diagnosis is approximately 5-7 cm; however, it is not uncommon for tumours to be as large as 30-40 cm and involving multiple viscera. METHODS: Data were retrospectively collected from patients with GISTs treated at the Singapore General Hospital and the National Cancer Centre Singapore over a 15-year period. Standard resection of GIST without any additional organ removal was termed as a single organ resection (SOR). If the tumour was adjacent to another organ, necessitating the removal of more than one organ, the procedure was defined as a multivisceral resection (MVR). We aim to evaluate the role of MVR in the management of large GISTs. RESULTS: A total of 187 patients underwent curative surgery for GIST between January 2000 and January 2014. Of the 187 patients, 40 (21%) underwent MVR whereas 147 (79%) had SOR. Patients in the MVR group had significantly larger tumour sizes (P < 0.001) yet R0 and R1 resection was achieved in all patients, and no intra-peritoneal rupture was reported. On comparison of MVR versus SOR groups, there was no significant difference in in-hospital morbidity and mortality. CONCLUSION: MVR may be required to achieve negative margins in patients with large GISTs, and can be performed with acceptable morbidity and mortality.
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