Clnical presentation and surgical treatment of small bowel gastrointestinal stromal tumors: retrospective analisys of 13 cases

Abstract

Introduction: Small bowel tumors are rare malignancies that account for 1-5% of all gastrointestinal tumors. Despite the progress in recent years in the treatment of small bowel tumors, their diagnosis is difficult to date because of nonspecific symptoms. To analyze the clinicopathologic characteristics, diagnostic options and complex treatment of 13 cases of small bowel gastrointestinal stromal tumors (GIST). Materials and Methods: 13 consecutive patients with small bowel G ISTs, 5 males (38.5%) and 8 females (61.5% ), male: female ratio 1:1.6, median age of 55.1 ± 3.3 (95% CE47.90-62.25) years (28-71 years), who underwent surgery from 2008 to 2014, were included in this study. The clinical records of the patients were analyzed retrospectively. Results: Abdominal pain (11 cases, 84.6%) was the most common complaint. Abdominal CT was routinely performed on 9 (69.2%) patients. The preoperative diagnosis was established in 7 (53.8%) cases by abdominal CT. In 5 cases the tumors manifested clinically with complications: hemorrhage - 2 (15.4% ) patients, obstruction - 2 (15.4%) patients and perforation - 1 (7.7%) patient. In 3 (23.1% ) patients the tumor was localized in the duodenum, in 8 (61.5%) - in the jejunum and in 2 (15.4%) - in the ileum. All patients received surgery: 2 - cephalic pancreatoduodenectomy, 9 - small bowel resection, 1 - duodenal resection and 1 - wedge resection. The distribution of stages of the disease was as follows: IA=23.1% (n=3), 11=7.7% (n=l), IIIA=30.7% (n=4), IIIB=23.1% (n=3) and I V= 15.4% (n=2). The mean number of tumors was 2.5 ± 0.7 (from 1 to 9). The mean maximum diameter of the tumors was 9.5 ± 1.3 (from 3.7 to 20) cm. All 13 patients (100% ) showed positivity for c-KIT(CD l l 7). The overall median number of mitoses/50HPF was 8.8 ± 1.2 (95% 0 :6 .1 5 -1 1 .5 4 ). The median number of mitoses/50HPF in patients with high risk of recurrence was 11.1 ± 1.1 (95% 0:8.60-13.62) (from 7 to 18) (n=9) and 3.7 ± 0.5 (95% 0 :2 .2 2 7 - 5.273) (from 3 to 5) (n=4) in patients with low risk of recurrence. A total of 9 (69.2%) patients received adjuvant treatment with imatinib mesylate 400mg/day. Conclusion: Clinical manifestations of small bowel GISTs are non-specific and preoperative diagnosis is difficult. Surgery is the only curative option in the complex treatment of this disease.