Repeated surgery improves survival in recurrent gastrointestinal stromal tumors: a retrospective analysis of 144 patients.

TY - JOUR

T1 - Repeated surgery improves survival in recurrent gastrointestinal stromal tumors: a retrospective analysis of 144 patients.

AU - Schurr, Paulus

AU - Kohrs, Dietmar

AU - Reichelt, Uta

AU - Kaifi, Jussuf

AU - Vashist, Yogesh

AU - Bachmann, Kai

AU - Bogoevski, Dean

AU - Yekebas, Emre F.

AU - Izbicki, Jakob R.

N1 - Copyright (c) 2009 S. Karger AG, Basel.

PY - 2009

Y1 - 2009

N2 - PURPOSE: Recurrence of a gastrointestinal stromal tumor (GIST) may require multimodal therapy and the role of repeated surgery in this concept is unclear. PATIENTS AND METHODS: A consecutive series of GIST patients treated by surgery, imatinib therapy or both was retrospectively reviewed, and long-term survival was studied by Kaplan-Meier analysis. RESULTS: Institutional primary surgeries before 1999 necessitated reclassification of the histopathological sections and 58/78 patients were classified as having true GIST. In primary surgeries, liver metastases were observed in GIST (6/58) but not in sarcoma/schwannoma patients (0/20), and exulceration of the primary tumor did not correlate with adverse outcome. Additionally, 86 patients were seen on an outpatient basis or were treated for recurrence at our institution, thus a total of 144 GIST patients were seen at our institution between 1994 and 2007 for either primary or secondary tumor manifestation. After 2003, 19/144 GISTs recurred and were treated by targeted therapy with imatinib. The patients showed better overall survival than historic controls. Imatinib therapy enhanced re-resectability due to tumor downsizing, and re-resection (n = 16) improved survival significantly (p = 0.046, log-rank test). CONCLUSION: A multimodal approach including targeted therapy and repeated surgery in the long-term management of recurrent GIST improves survival.

AB - PURPOSE: Recurrence of a gastrointestinal stromal tumor (GIST) may require multimodal therapy and the role of repeated surgery in this concept is unclear. PATIENTS AND METHODS: A consecutive series of GIST patients treated by surgery, imatinib therapy or both was retrospectively reviewed, and long-term survival was studied by Kaplan-Meier analysis. RESULTS: Institutional primary surgeries before 1999 necessitated reclassification of the histopathological sections and 58/78 patients were classified as having true GIST. In primary surgeries, liver metastases were observed in GIST (6/58) but not in sarcoma/schwannoma patients (0/20), and exulceration of the primary tumor did not correlate with adverse outcome. Additionally, 86 patients were seen on an outpatient basis or were treated for recurrence at our institution, thus a total of 144 GIST patients were seen at our institution between 1994 and 2007 for either primary or secondary tumor manifestation. After 2003, 19/144 GISTs recurred and were treated by targeted therapy with imatinib. The patients showed better overall survival than historic controls. Imatinib therapy enhanced re-resectability due to tumor downsizing, and re-resection (n = 16) improved survival significantly (p = 0.046, log-rank test). CONCLUSION: A multimodal approach including targeted therapy and repeated surgery in the long-term management of recurrent GIST improves survival.

KW - Antineoplastic Agents

KW - Benzamides

KW - Clinical Protocols

KW - Combined Modality Therapy

KW - Female

KW - Gastrointestinal Stromal Tumors

KW - Humans

KW - Imatinib Mesylate

KW - Kaplan-Meier Estimate

KW - Leiomyoma

KW - Leiomyosarcoma

KW - Longitudinal Studies

KW - Male

KW - Middle Aged

KW - Neoplasm Recurrence, Local

KW - Neurilemmoma

KW - Piperazines

KW - Pyrimidines

KW - Reoperation

KW - Retrospective Studies

KW - Treatment Outcome

U2 - 10.1159/000219932

DO - 10.1159/000219932

M3 - SCORING: Journal article

C2 - 19468233

VL - 26

SP - 229

EP - 235

JO - DIGEST SURG

JF - DIGEST SURG

SN - 0253-4886

IS - 3

M1 - 3

ER -