Abstracts
2002 Digestive Disease Week

# 104977 Abstract ID: 104977 Surgical Management of Gastrointestinal Stromal Tumors: A Single Institution 33-Year Experience
David T Efron, Keith D Lillemoe, John L Cameron, Sean Tierney, Susan C Abraham, Richard F Heitmiller, Ralph H Hruban, Elizabeth Montgomery, Charles J Yeo, Baltimore, MD

Stromal tumors of the gastrointestinal tract (GIST) continue to be a rare and poorly understood neoplasm. Definitive management is frequently uncertain because of difficulty in predicting the malignant behavior of these tumors. Surgical resection remains the mainstay of therapy. We describe a 33 year single institution experience which represents the largest reported series of surgical management of these tumors. Patients were identified through the institutional pathology specimen database and a retrospective analysis was performed of all hospital records. Pathologic diagnosis was confirmed and tumors were localized to a specific segment of the gastrointestinal tract. The search identified 173 patients with GIST between January 1968 and September 2001. Follow-up was obtained as of December 2001. By site: 7% of the tumors were esophageal, 57% were gastric, 10% were duodenal, 17% were jejuno-ileal and 8% were colo-rectal in origin. 58% of patients were male with a mean age a presentation of 60.2 years. For 123 patients (72%) the GIST was identified as the primary indication for operation while the remaining 50 GIST (28%) were identified at operation for other pathology. Gastrointestinal bleeding was the most common presenting symptom occurring in 34% of all cases followed by abdominal pain (23%) and abdominal mass (20%). Surgical therapy depended upon site of disease and the extent of invasion of the primary organ. Follow up was available for 105 of the 123 patients with primary GIST (85%). Univariate analysis (Kaplan-Meyer survival plot, Log-rank test) identified tumor size >10cm (p=0.03) and site of origin (p=0.02) and predicting survival. Thirty-five patients (28%) have been identified with recurrent disease, with a mean time to recurrence of 19 months (range 4-114 months). The most common site of recurrence was liver(67%) followed by local recurrence at the operative site (30%)and disseminated disease (25%). GIST remain rare neoplasms that continue to pose a therapeutic challenge. These data support the use of aggressive surgical management and early close follow up in the treatment of these neoplasms. The role of new tumor-specific chemotherapy is still undefined.