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La sede anatomica come fattore prognostico nei tumori gastrointestinali stromali (GIST): nostra esperienza

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Background: GISTs are the most common mesenchimal tumors and
represent approximately 1% of all of the gastrointestinal tract cancers.
The treatment for localized GISTs is the surgical excision with macroscopically
negative margins. However, recurrence is a relatively common
event even after a complete resection. Almost 30% of recurrences are locally
and distant metastases represent the 50% of total recurrences.
Materials and methods: From July 2002 to March 2009 a total of
nineteen patients (12 males, 7 females), median age 65 years (49-79),
underwent curative resection (R0). Tumor site: stomach 12; small intestine
5; colon rectum 2. Surgical treatments: segmental resection of small
intestine (5); gastric wedge resection (9), subtotal gastrectomy (2); gastric
resection extended to distal splenopancreasectomy (1); right colectomy (1);
anterior resection (1).
Results: Gastric GISTs were high grade in 4 patients, intermediate
in 1 patient and low-risk in 7 patients. Small intestine GISTs were high
grade in 2, intermediate in 2 and low in 1 patient, respectively. Colorectal
GISTs were high in 1 and intermediate in 1 patient, respectively.
Lymphonodal metastases were found in one patient with high risk stomach
GIST. After a median follow up of 40 months, 15 patients are alive
and free disease; 4 male patient (1 high risk stomach, 1 intermediate and
I low risk small intestine, 1 high risk rectum) have a recurrence, two local
(pelvis) and 2 distant (liver), respectively. The rate of relapse is 8% in
stomach, 40% in small intestine and 50% in rectum.
Discussion: Several studies have shown that different anatomical locations
of GISTs have different clinical, histological, immunohistochemical
and genetic characteristics, suggesting that the anatomical location
could be a prognostic factor independent of tumor size and mitotic rate.
Our experience confirms data from the literature.

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