Researchers reported similar survival outcomes for local and radical excisions even though the optimal surgical approach for rectal gastrointestinal stromal tumors (GISTs) is still in debate, as published in BMC Surgery.

“Although [radical excision] achieves a prolonged surgical margin, no differences were detected in the [cancer-specific survival] time,” the authors said.

The median cancer-specific survival times were 53 months and 46 months in the local excision and radical excision groups respectively, but the differences didn’t meet the criteria for statistical significance (logrank=0.704, P =.401). Therefore, local excision might be an effective surgical approach for rectal GISTs.


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Moreover, the authors did not identify any differences in cancer-specific survival time between the 2 groups with respect to T and N classification, tumor differentiation, tumor size, regional lymph node surgery, age, gender, race, chemotherapy, and radiotherapy.

Additional survival analyses identified T classification and patients’ ages as independent prognostic factors in rectal GISTs. Patients with T3–4 rectal GISTs were at a 1.7-fold risk of death compared to those with T1–2 rectal GISTs (P =.024).

Also, patients aged >60 years were at a 2.6-fold risk of death as compared to those ≤60 years (P =.003). None of the other variables analyzed were identified as independent prognostic factors.

The retrospective study conducted by Wei et al enrolled 154 patients with rectal GISTs obtained from the Surveillance, Epidemiology, and End Results database. Eighty-four patients underwent radical excision, while 70 were treated with local excision.

Both surgical approaches are feasible in patients with rectal GISTs, albeit with advantages and disadvantages. Evidence suggests that radical excision is associated with lower local recurrence when compared to local excision, though with more adverse events, including large trauma and severe bowel dysfunction, and poorer quality of life.

Reference

Wei J, Zhong J, Chen Z, et al. Survival outcome of local vs. radical excision in rectal gastrointestinal stromal tumor: a SEER database analysis. BMC Surg. 2022;22(1):21. doi:10.1186/s12893-022-01485-3