GIST:
La chirurgia della malattia
primaria e localizzata
Fausto Catena
U.O. di Chirurgia Generale, d’Urgenza e dei Trapianti
Direttore Prof AD Pinna
Policlinico S.Orsola- Malpighi, Università di Bologna
QUADRO CLINICO
Dolore addominale
Perforazione intestinale
diagnosi casuale
Emorragia digestiva
Occlusione intestinale
Fino al 50% dei pazienti si presenta
con emorragia digestiva
d.d. emorragie digestive
DIAGNOSI STRUMENTALE
endoscopia
TC
PET
Indagini strumentali
Biopsia ?
Rx con m.d.c.
Eco
ultrasonografia endoscopica
Biopsia e GIST
•
•
•
•
Rottura GIST
Dissemininazione
Emorragia
Indicata in casi di dubbi clinici (d.d. con
linfoma)
• Se non resecabile per la neoadiuvante
IL PROBLEMA DELL’ESTEMPORANEA
E DELLA FNA
Cancer. 2005 Aug 29; [Epub ahead of print]
The utility of fine-needle aspiration in the diagnosis of
gastrointestinal stromal tumors.
Elliott DD, Fanning CV, Caraway NP.
TERAPIA
chirurgia
Terapia molecolare mirata
J Surg Oncol. 2005 Jun 1;90(3):195-207; discussion 207.
Gastric GI stromal tumors (GISTs): the role of surgery in the era of targeted
therapy. Heinrich MC, Corless CL.
Management of gastrointestinal stromal tumors in the imatinib era: selected case studies.
Oncologist. 2006 Jan;11(1):9-20 Benjamin RS, Blanke CD, Blay JY, Bonvalot S,
Eisenberg B.
Ann Chir. 2005 Mar;130(3):144-51. Epub 2004 Nov 18.
Surgical management of GIST in the era of Gleevec
Bonvalot S.
www.glivec.com
Surg Oncol. 2005 Aug;14(2):75-84.
The role of surgery in the management of gastrointestinal stromal
tumors (GISTs) in the era of imatinib mesylate effectiveness.
Kosmadakis N
TERAPIA: razionale
• Resezione radicale con margini
negativi
• Non vi è relezione tra estensione
resezione e sopravvivenza
Evans, Cancer 1985; 56: 2242- 2250
Localizzazioni gastriche < 5 cm
resezioni wedge
Localizzazioni gastriche > 5 cm
gastroresezione
Lindsay J Surg Onc 1981; Wayne JD, Bell RH Jr. Surg Clin North Am. 2005
Oct;85(5):1009-20. Limited gastric resection.
Linfoadenectomia
Non vi è di solito
coinvolgimento
linfonodale
NO
Linfoadenectomia
sistematica
RESEZIONI GASTRICHE
LAPAROSCOPICHE
Novitsky YW, Kercher KW, Sing RF, Heniford BT.
Long-term outcomes of laparoscopic resection of gastric
gastrointestinal stromal tumors.
Ann Surg. 2006 Jun;243(6):738-45; discussion 745-7.
Catena F, Di Battista M, Fusaroli P, Ansaloni L, Di Scioscio V,
Santini D, Pantaleo M, Biasco G, Caletti G, Pinna A.
Laparoscopic treatment of gastric GIST: report of 21 cases and
literature's review.
J Gastrointest Surg. 2008 Mar;12(3):561-8. Epub 2007 Nov 27
Hindmarsh A, Koo B, Lewis MP, Rhodes M.
Surg Endosc. 2005 Aug;19(8):1109-12. Epub 2005 Jun 23.
Laparoscopic resection of gastric gastrointestinal stromal tumors.
MARCATURA DEL GIST/
ECOGRAFIA INTRAOPERATORIA
GIST DUODENO
Cavallini M, Cecera A, Ciardi A, Caterino S, Ziparo V. Small periampullary
duodenal gastrointestinal stromal tumor treated by local excision: report of
a case. Tumori. 2005 May-Jun;91(3):264-6.
De Marco G, Roviello F, Marrelli D, De Stefano A, Neri A, Rossi S, Corso G,
Rampone B, Nastri G, Pinto E. A clinical case of duodenal gastrointestinal
stromal tumor with a peculiarity in the surgical approach. Tumori. 2005 MayJun;91(3):261-3
Goh BK, Chow PK, Ong HS, Wong WK.
Gastrointestinal stromal tumor involving the second and third portion of
the duodenum: treatment by partial duodenectomy and Roux-en-Y
duodenojejunostomy. J Surg Oncol. 2005 Sep 15;91(4):273-5.
Akkus MA, Kismet K, Erel S, Adibelli MA, Pulat H.
Case report: duodenal stromal tumor.
Acta Gastroenterol Belg. 2005 Jan-Mar;68(1):95-7.
?
Resezioni segmentarie di tenue
GIST ESOFAGO
Dis Esophagus. 2005;18(1):70-3.
Esophageal GIST: therapeutic implications of an uncommon
presentation of a rare tumor.
Gouveia AM, Pimenta AP, Lopes JM, Capelinha AF, Ferreira SS,
Valbuena C, Oliveira MC.
GIST RETTO
Dis Colon Rectum. 2005 Jun;48(6):1316-9.
Neoadjuvant imatinib in gastrointestinal stromal tumor of the
rectum: report of a case.
Lo SS, Papachristou GI, Finkelstein SD, Conroy WP, Schraut
WH, Ramanathan RK.
NEOADIUVANTE
Gastrointest Endosc. 2005 Apr;61(4):625-7.
Neoadjuvant therapy with imatinib mesylate
for locally advanced GI stromal tumor.
Shah JN, Sun W, Seethala RR, Livolsi VA, Fry
RD, Ginsberg GG.
Gan To Kagaku Ryoho. 2005 Nov;32(12):1941-4.
Stomach Successfully Treated with Imatinib Mesylate
Neoadjuvant Therapy and Followed Postoperatively.]
Okuda H, Tanaka H, Ueno M, Shitani M, Nasuno M,
Suzuki C, Nishimura S, Kimura H, Yonezawa K, Abe
T, Yoshida Y, Kawabata M.
CONCLUSIONI
I GIST rappresentano un
gruppo eterogeneo di
neoplasie con terapia
chirurgica particolare