Laparoscopic treatment of GISTs. Personal experience

Abstract

Gastrointestinal stromal tumours are rare neoplasms originating from the connective tissue of the digestive tract and constitute most of the non-epithelial primitive digestive tumours.

The origin from the interstitial cell of Cajal is appreciated because of this tumours constantly present the expression of the surface antigens CD34 and CD117 which can be determined immunohisto-chemically.

In the majority of cases, GISTs are symptomatic and symptoms are most commonly related to mass effect or bleeding.

Asymptomatic GISTs are often found incidentally on physical examination, radiologic imaging, endoscopy, laparotomy or laparoscopy. US endoscopy and fine needle aspiration with subsequent immunohistochemical analysis afford the best diagnostic accuracy.

In primary and localizated GISTs surgery is always indicated and laparoscopic technique is feasible and is recommended as the treatment of choice for all the patients. Imatinib should be started in metastatic or recurrent disease and neoadjuvant imatinib is also experimental, although its use may be justified in unresectable or marginally resectable GIST. Sunitinib has recently been approved for patients with GIST, principally those who fail imatinib therapy.

Our experience is based on the study of 7 GISTs: only in 2 cases the neoplasm was found occasionally; in the other, symptoms were related to mass effect or bleeding. Laparoscopic tumour resection was then performed in all the patients. The definitive diagnosis of gastrointestinal stromal tumour, was made postoperatively by analysis of the histopathological and immunohistochemical findings. We confirmed constant high positivity for CD34 and for CD117. Even in the absence of unfavourable prognostic indicators, all patients are regularly followed-up.