gms | German Medical Science

126. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

28.04. - 01.05.2009, München

Outcome and Prognostic Factors After Resection of Gastrointestinal Stromal Tumors

Meeting Abstract

  • corresponding author K. Krajinovic - Universitätsklinikum Würzburg, Chirurgie I, Würzburg, Deutschland
  • C.T. Germer - Universitätsklinikum Würzburg, Chirurgie I, Würzburg, Deutschland
  • A. Agaimy - Universitätsklinikum Erlangen, Pathologie, Erlangen, Deutschland
  • P.H. Wünsch - Klinikum Nürnberg Nord, Pathologie, Nürnberg, Deutschland
  • C. Isbert - Universitätsklinikum Würzburg, Chirurgie I, Würzburg, Deutschland

Deutsche Gesellschaft für Chirurgie. 126. Kongress der Deutschen Gesellschaft für Chirurgie. München, 28.04.-01.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. Doc09dgch11336

DOI: 10.3205/09dgch555, URN: urn:nbn:de:0183-09dgch5558

Published: April 23, 2009

© 2009 Krajinovic et al.
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Outline

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Introduction: The aims of this study were to evaluate the outcome after surgical resection in patients with gastrointestinal stromal tumors and to determine factors influencing local tumor recurrence or distant metastatic disease after locally complete tumor resection (R0).

Material and methods: Outcomes of one hundred patients with primary gastrointestinal stromal tumors (GIST) surgically managed between 1997 and 2006 at a single institution were reviewed. Univariate and bivariate analyses were used to determine factors affecting recurrence-free and tumor-free survival.

Results: All patients (n=100) had c-kit-positive GIST. There were 17% very low risk, 41% low risk, 19% intermediate risk and 23% high risk GIST originating from the stomach (70%), small bowel (28%), colon and rectum (2%) Median patient age was 68 (range, 39–92) years. Seventy-three percent of patients had symptomatic local disease. Most (94%) underwent R0 resections of their primary tumor. R0 resection was significantly associated with a lower tumor-related mortality rate (p=0.0001). The patients with recurrence/metastases had significantly larger tumors (p=0.0017) and a mitotic index higher than 5 (p=0.0001).Seven of 20 patients from the high-risk group and two of 7 patients with metastatic disease developed local recurrence or further metastastatic tumor spread following R0 resection. The average (statistical mean) time until local recurrence or development of distant metastases after R0 resection was 14 months in the intermediate-risk group and 23 months in the high-risk group.

Conclusion: Surgical removal continues to be the mainstay of GIST treatment. R0 resection, tumor size and mitotic index are significant prognostic factors. Overall, more than 30% of patients with high-risk GIST develop local recurrences and distant metastases despite R0 resection. Additional molecular pathological markers are needed to yield a more accurate tumor profile and to thus achieve a better predictability of the biological behaviour of GIST.