Management of gastrointestinal stromal tumors: a prospective and retrospective study

Background: Gastrointestinal stromal tumors (GISTs) are a group of unusual neoplasms arising from the interstitial cells of Cajal. GISTs are the most common mesenchymal tumors of the gastrointestinal (GI) tract. Diagnosis always requires immunohistochemical staining for the expression of c- KIT protein ( CD-117). Purpose: The aim of this study was to present the prospective and retrospective experience of the Gastrointestinal Surgery Department, Alexandria Faculty of Medicine, in the management of GISTs. Materials and methods: This study was carried out on 102 patients: a prospective study on 22 patients from April 2013 to April 2015 and a retrospective study on 80 patients between January 2009 and March 2013. All patient data, the different clinical presentations, the impact of surgical treatment, complications, follow-up, and survival data were collected and analyzed. Results: This study included 102 patients (63 men and 39 women) who presented with GISTs on clinical, radiological, and/or endoscopic aspects. Their mean age at diagnosis was 49.18 ± 14.58 years. The most frequent presenting symptom was GI bleeding, seen in 42 patients (41.18%). Twenty-fi ve patients (24.51%) presented with abdominal swelling and pain. Twenty-four patients (23.53%) presented with anemia for investigation. Eight patients (7.84%) presented with repeated attacks of abdominal pain only. The tumors were located in the stomach in 54 patients (52.9%). Upper gastrointestinal endoscopy was performed in 64 patients (62.75%). Upper gastrointestinal endoscopy revealed the presence of a gastric lesion in 46 patients and a duodenal lesion in six patients and was completely free in 12 patients. Complete resection was achieved in 92 patients (92%), whereas eight patients (8%) had incomplete resection. Conclusion: This study concludes that GISTs can occur anywhere in the GI tract but most commonly in the stomach. The prognosis is strictly related to the size of the tumor, number of mitoses, and completeness of surgical resection.