GIST: La chirurgia della malattia

primaria e localizzata

Fausto CatenaU.O. di Chirurgia Generale, d’Urgenza e dei Trapianti

Direttore Prof AD Pinna

Policlinico S.Orsola- Malpighi, Università di Bologna

QUADRO CLINICO

diagnosi casuale

Dolore addominale Perforazione intestinale

Emorragia digestiva Occlusione intestinale

Fino al 50% dei pazienti si presenta con emorragia

digestiva

d.d. emorragie digestive

Indagini strumentali

endoscopia TC

Rx con m.d.c. Ecoultrasonografia endoscopica

Biopsia ?

DIAGNOSI STRUMENTALE

PET

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

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

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.

Ann Chir. 2005 Mar;130(3):144-51. Epub 2004 Nov 18.Surgical management of GIST in the era of GleevecBonvalot S.

www.glivec.com

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.

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

gastroresezioneLindsay 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 solitocoinvolgimentolinfonodale

NOLinfoadenectomia

sistematica

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.

RESEZIONI GASTRICHE LAPAROSCOPICHE

MARCATURA DEL GIST/ECOGRAFIA INTRAOPERATORIA

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 May-Jun;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.

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.

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.

GIST DUODENO

?

Resezioni segmentarie di tenue

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 ESOFAGO

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.

GIST RETTO

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.

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.

NEOADIUVANTE

CONCLUSIONI I GIST rappresentano un

gruppo eterogeneo di neoplasie con terapia chirurgica particolare