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. 2024 Feb;13(1):51-56.
doi: 10.5582/irdr.2023.01112.

Surgical outcomes of locally advanced gastrointestinal stromal tumors after multivisceral resection: A retrospective study of 64 patients at a single institution

Hui Qiu  1 , Zhen Wang  1 , Bonan Liu  1 , Rongze Sun  1 , Xiuyun Tian  1 , Chunyi Hao  1
Affiliations

Surgical outcomes of locally advanced gastrointestinal stromal tumors after multivisceral resection: A retrospective study of 64 patients at a single institution

Hui Qiu et al. Intractable Rare Dis Res. 2024 Feb.

Abstract

To analyze the outcome in patients who have undergone multivisceral resection (MVR) for locally advanced gastrointestinal stromal tumors (GISTs), and identify the risk factors for tumor recurrence and postoperative morbidity. Sixty-four patients who operated for locally advanced GISTs with MVR in PPeking University Cancer Hospital Sarcoma Center (PUCHSC) between 2013 and 2021 were identified. Clinicopathologic characteristics, surgical outcomes, recurrence, and 5-year recurrence-free and overall survival were evaluated. The mean age of the patients was 60 years. Mean tumor size was 11.1 cm. Complete resection was achieved in all patients. The estimated 5-year recurrence-free and overall survival were 86.6% and 90.0%, respectively. Independent factor of recurrence following surgery was mitotic count on multivariate analysis. Overall postoperative morbidity was 53.1% (n = 34). Severe morbidity was 21.9% (n = 14). The most common severe complication was clinically relevant pancreatic fistula (n = 12, 18.8%), followed by anastomotic leakage (n = 4, 6.3%) and Intraabdominal abscess (n = 4, 6.3%). Multivariate analysis showed that preoperative imatinib therapy could reduce overall morbidity. Long operation time, combined colectomy and pancreatectomy were independent risk factors for postoperative severe morbidity. Compared to partial pancreatectomy, pancreaticoduodenectomy (PD) was significantly increased the incidence of severe morbidity. In conclusion, compared to systemic therapy alone, the outcome of locally advanced GISTs after MVR was more favorable. Despite the high overall morbidity, the postoperative severe morbidity and mortality of MVR were acceptable. Preoperative imatinib therapy should be recommended whenever possible. Combined pancreatectomy and colectomy are associated with significant postoperative severe morbidities. PD should be thoroughly discussed and be subject to MDT approach before surgery.

Keywords: gastrointestinal stromal tumors; multivisceral resection; postoperative morbidity; pancreatectomy; surgical outcomes.

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Conflict of interest statement

This work was supported by the Beijing Xisike Clinical Oncology Research Foundation (approval No.: Y-Young2021-0111), Beijing Municipal Administration of Hospitals' Ascent Plan (approval No.: DFL20181104), Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support (approval No.: XMLX201708), the Capital Health Research and Development of Special Funds (approval No.: 2016-2-2151), and National Natural Science Funding (approval No.: 31770836), Science Foundation of Peking University Cancer Hospital 2020-14.The authors have no conflicts of interest to disclose.

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