Although local surgical excision of a rectal gastrointestinal stromal tumor (GIST) may be associated with a higher incidence of positive margins than radical excision, there is no significant difference in overall survival between the 2 approaches, according to a recently published study in the World Journal of Surgery.

Rectal GISTs are an uncommon finding associated with a poor overall prognosis. Currently, the best therapeutic option is surgical excision. Local surgical excision is preferred for small tumors, while radical excision is preferred for more advanced tumors. However, there are no clear criteria for selecting between the 2 approaches in each case, mainly due to the low incidence of the disease. 

The authors used data from the National Cancer Database (NCDB) to compare outcomes of local and radical excision. None of the cases included in the study presented with node involvement or distant metastasis.


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The study’s primary outcome was overall survival after 5 years. Secondary outcomes included surgical margins, length of hospital stay, and mortality at 30 and 90 days. 

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The study included more than 220 patients with rectal GIST, with a mean age of 60 years. Over 60% of patients had a tumor smaller than 5 cm, and most patients had low-grade tumors. The average follow-up period was 60 months.

Approximately 55% of patients underwent local excision, and approximately 45% underwent radical excision. Most patients who underwent radical excision also received adjuvant chemotherapy.

The 5-year overall survival rate was 86%. Both groups had similar outcomes, with the exception that patients who underwent local excision were more likely to have positive margins.

“Based on these findings, and despite the higher incidence of positive resection margins, local excision might be a suitable first line option for rectal GISTs, especially for tumors smaller than 5 cm in size,” the authors wrote. 

Reference

Emile SH, Horesh N, Freund MR, et al. Outcomes of local excision compared to radical excision of rectal gastrointestinal stromal tumors: a propensity-score matched analysis of the NCDB. World J Surg. Published online October 11, 2022. doi:10.1007/s00268-022-06778-5