EARLY RESULTS OF THE SURGICAL MANAGEMENT OF GASTROINTESTINAL STROMAL TUMORS (GIST) - THE EXPERIENCE OF THE 3rd SURGICAL UNIT

This study provides a clinical and paraclinical algorithm of assessment of gastrointestinal stromal tumors (GIST), with the possibilities and limits of their current management. It is focused on defining an optimal imaging and anatomoclinic diagnosis protocol. In the absence of specific algorithm of surgical management, the study proposes an evaluation of possible histologic diagnosis and the indication for surgery, and the assessing the immediate results of thesurgical treatment. Materials and methods. A retrospective analysis was carried out over a period of 8 years (2004-2011), including patients with pathologic results of resection specimens revealing the stromal nature. There were analyzed the tumor characteristics, the association with other digestive tumors, the biologic behavior, clinical manifestations and the comorbidities of the patient, the indication for surgery, and also, the surgical morbidity and mortality. From 2004 to 2011 there have been operated 24 cases of GIST diagnosed histologically by common stains. Among them, a total of 16 patients (beginning with 2007) were confirmed immunohistochemicaly. Results. During the study, each clinical suspicion of GIST was an opportunity for thorough assessment of the clinical picture, imaging studies or anatomoclinical aspects (intraoperative macroscopical aspects, pathological and immunhistochemical examination). We have tried a standardization of diagnostic and therapeutic algorithm. Positive diagnosis of GIST was clinicaly suspected in patients with digestive tract tumors (22 cases out of 24) without mucosal involvement, or based on intraoperative macroscopic appearance. The lesions were confirmed by the pathologist. The surgical morbidity (4 cases - 16.6%), was to the surgery (a single case of anastomotic leakage) or due to patient's comorbidities (diabetus, chronic renal failure, etc), and has been framed to acceptable extent. No deaths occurred in relation to the surgery. Conclusions. The diagnostic difficulties are overcome in terms of a positive laboratory features revealed by immunhistochemical examination. The surgical approach of GIST is different from that of a carcinoma. The postoperative immunhistochemical confirmation of GIST, leads the patient to a specific adjuvant treatment.