Small bowel gastrointestinal stromal tumors (GIST) appear to be associated with a higher frequency of emergency surgery, more advanced T stage at the moment of diagnosis, and a shorter disease-free survival rate than gastric GISTs, according to a recently published study in the Asian Journal of Surgery.

GISTs are more commonly observed in the stomach and the small bowel, with colorectal, esophageal, and anal GISTs accounting for approximately 15% to 20% of cases, the authors noted. Since upper endoscopy screening is recommended in all patients over 40 in Korea, gastric GISTs in this country are usually detected early and have a better prognosis, they added.

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“With this background, we investigated in this study about the comparison of the clinical, surgical and oncologic outcome for gastric GIST and small bowel GIST,” the authors wrote.

The retrospective study included 165 patients that underwent surgery for either gastric (n=115) or small bowel (n=50) GIST between the last 7 months of 2017, in which R0 resection was expected before the surgery. The surgical approach varied among patients according to the intrinsic patient and tumor characteristics. All the patients included in the study had close follow-ups until 2021 or the time of death.

There was no significant difference in demographic characteristics and adjuvant chemotherapy frequency among the gastric and small bowel groups.

Results revealed that the rate of asymptomatic GIST was higher in the gastric GIST group, with almost 70% compared to 34% in the small bowel group. Emergency surgery was 5 times more common in the context of small bowel GIST than in gastric GIST, with more than 60% of small bowel GIST surgery being performed openly in contrast with 10% in gastric GIST.

Regarding tumor staging, small bowel GISTs tended to have a more advanced T staging; however, there was no significant difference in both groups’ mitotic rate and risk category NHS. The 5-year survival rate was 3% higher in the gastric GIST group (100% vs 97%), and the disease-free survival rate was 10% higher in the gastric GIST group.

“To reveal the factors that affect the worse prognosis of small bowel GIST, further investigations and large scaled studies are needed,” the authors concluded.

Reference

Park N, Lim DR, et al. Comparison of clinical characteristics and outcomes after surgery of gastric and small bowel gist in single center experiences. Asian J of Surg. Published online January 3, 2023. doi:10.1016/j.asjsur.2022.12.114