1. Preoperative imatinib and laparoscopic intersphincteric resection for large rectal gastrointestinal stromal tumor: A case report
- Author
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Yuichiro Doki, Norikatsu Miyoshi, Mamoru Uemura, Takayuki Ogino, Hiroaki Itakura, Shiki Fujino, Shinnosuke Nagano, Masaki Mori, Hidekazu Takahashi, Chu Matsuda, Tsuyoshi Takahashi, and Tsunekazu Mizusima
- Subjects
Endoscopic ultrasound ,Laparoscopic surgery ,medicine.medical_specialty ,medicine.medical_treatment ,Rectum ,Article ,GIST, gastrointestinal stromal tumor ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Laparoscopic intersphincteric resection ,Stromal tumor ,neoplasms ,Rectal gastrointestinal stromal tumor ,medicine.diagnostic_test ,GiST ,business.industry ,Abdominoperineal resection ,digestive system diseases ,Surgery ,medicine.anatomical_structure ,Imatinib mesylate ,Fine-needle aspiration ,IM, imatinib mesylate ,ISR, intersphincteric resection ,030220 oncology & carcinogenesis ,Imatinib ,030211 gastroenterology & hepatology ,business - Abstract
Highlights • Rectal GIST is a rare disease, and have often grown by the time of discovery due to lack of initially subjective symptoms. • A large rectal GIST often require extensive surgery which may lead to postoperative bowel dysfunction. • Preoperative chemotherapy with imatinib mesylate is effective for reducing the rectal GIST. • Laparoscopic intersphincteric resection may be a useful technique for giant rectal GIST, which enables anal preservation., Introduction Anus-preserving surgery for a large rectal gastrointestinal stromal tumor (GIST) may be difficult because of the location of the tumor in the pelvis. Therefore, rectal GIST might require extensive surgery, such as abdominoperineal resection. In recent years, preoperative imatinib therapy has been used to reduce tumor size and preserve the anus in some cases. However, there have been few reports of laparoscopic anal-preserving surgery for giant rectal GIST. Presentation of a case We present the case of a 55-year-old man who was referred to our hospital for examination of a 10-cm pelvic mass in the lower rectum. Endoscopic ultrasound with fine needle aspiration was performed, and the pathological findings resulted in a diagnosis of GIST. The mass had spread to the prostate and left levator ani muscles, and as a result, surgery was deemed difficult to perform without damaging the pseudo-capsule. Therefore, preoperative chemotherapy with imatinib mesylate (IM) was performed for 8 months. The mass was reduced to 7.8 cm, and laparoscopic intersphincteric resection (ISR) was performed. Discussion We also review prior cases of rectal GIST where patients had undergone anal-preserving surgery following preoperative chemotherapy with IM. Our case represented the largest tumor size in a review of cases of patients who had successful anal-preserving laparoscopic surgery following preoperative chemotherapy with IM. Conclusion Preoperative chemotherapy with imatinib mesylate was effective for reducing the rectal GIST, and laparoscopic ISR was useful for anal preservation, even when a tumor is large.
- Published
- 2020