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Ann Surg. 2015 Jan;261(1):117-24. doi: 10.1097/SLA.0000000000000505.

Esophageal gastrointestinal stromal tumor: is tumoral enucleation a viable therapeutic option?

Author information

1
*Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Lille, France †North of France University, Lille, France ‡Integrated Research Center in Oncology: SIRIC ONCOLille, Lille, France §Inserm, UMR837, Jean-Pierre Aubert Research Center, Team 5 Mucins, Epithelial Differentiation and Carcinogenesis, Lille, France ¶University Hospital Croix-Rousse, Lyon, France ∥Institut Mutualiste Montsouris, Paris, France.

Abstract

OBJECTIVE:

The primary objective was to evaluate the feasibility of surgical enucleation of esophageal gastrointestinal stromal tumors (E-GISTs). Secondary objectives evaluated (i) the impact of tumor enucleation on oncological outcomes, (ii) the effect of pretherapeutic biopsy on the feasibility of E-GIST enucleation, and (iii) the impact of mucosal ulceration on outcome.

BACKGROUND:

E-GISTs are very rare tumors and esophageal resection has been the recommended approach. The feasibility and impact on outcomes of tumor enucleation are unknown.

METHODS:

Through a large national multicenter retrospective study, 19 patients with E-GISTs were identified between 2001 and 2010. Patients who underwent either enucleation or esophagectomy were compared.

RESULTS:

Of over 19 patients identified with E-GISTs, curative treatment was surgical for 16 patients, with enucleation in 8 and esophagectomy in 8. In the enucleation group, median tumoral diameter was 40 mm (18-65 mm), without any mucosal ulceration, preoperative capsular ruptures, or incomplete resections. In the esophagectomy group, the median tumoral diameter was 85 mm (55-250 mm), with mucosal ulceration in 4 patients, preoperative capsular rupture in 1, and no incomplete resections. Severe postoperative complication rates were 50% and 25% in the esophagectomy and enucleation groups, respectively, with 2 postoperative deaths after esophagectomy. After a median follow-up of 6.4 years, 2 recurrences were observed after esophagectomy versus 0 after enucleation. Endoscopic biopsies did not expose patients to complications or local recurrence after enucleation. Endoscopic mucosal ulceration was associated with more aggressive tumors.

CONCLUSIONS:

E-GIST enucleation seems safe for tumors of less than 65 mm in diameter.

PMID:
25062398
DOI:
10.1097/SLA.0000000000000505
[Indexed for MEDLINE]

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