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Surgical Treatment of Gastrointestinal Stromal Tumors (GIST) of the Stomach - Data Analysis of the East German Gastric Cancer Study (“Eggc Study '02“)
Meyer Frank*1,5, Karsten Ridwelski2,5, Lutz Meyer3,5, Uwe Schmidt6,5, Henry Ptok4,5, Hans Lippert1,5, Ingo Gastinger5
1Dept. of General, Abdominal & Vascular Surgery, University Hospital, Magdeburg, Germany; 2Dept. of General & Abdominal Surgery, Municipal Hospital, Magdeburg, Germany; 3Dept. of Surgery, Municipal Hospital, Plauen, Germany; 4Dept. of Surgery, Municipal Hospital, Cottbus, Germany; 5Institute for Quality Assurance in Operative Medicine, University Hospital, Magdeburg, Germany; 6StatConsult, StaConsult, Magdeburg, Germany
Background: Within the East German Gastric Cancer Study (“EGGC 02”), 1,199 gastric tumor lesions were documented. As a separate tumor entity, gastrointestinal stromal tumors (GIST, n=55) were compared with gastric adenocarcinomas. The evaluation aimed, in particular, on early postoperative and oncosurgical outcome as a parameter for the quality of surgical results. In near future, data of a re-initiated, currently ongoing study over a 3-year time period (n=approximately 300 patients) can be compared to elucidate what (neo-)adjuvant treatment can additionally achieve with regard to the oncosurgical outcome of gastric GIST patients.
Patients and methods: A systematic clinical multicentre observational study design with prospective items in a well characterized area (East Germany) was used including hospitals of each level of surgical care.
Results: From January 01 to December 31, 2002, data of 1,199 patients with gastric tumor lesions from 80 hospitals were documented. Ninety five % of 1,139 gastric carcinomas were preoperatively diagnosed with histologic investigation whereas this rate was 47.3 % in 55 GISTs. 61.8 % of the GIST patients were treated with local wedge resections or with a limited approach. The rate of radical surgical interventions (30 %; e.g., gastrectomy, multivisceral resection) was relatively high. The surgical results achieved by operation alone showing i) a hospital mortality of 1.8 %, and ii) a 5-year-survival rate of 78 % (follow-up investigation period, 67 months; including 90.9 % of all patients) compared with gastric carcinoma (30.6 %, 70 months and 87.4 %, respectively) are acceptable.
Discussion: Results achieved by surgical intervention alone as reported can serve as an appropriate basis for the initiation and comparison of multimodal therapeutic concepts with the (neo-)adjuvant use of the tyrosin kinase inhibitor Imatinib according to the currently relevant guidelines (as being expected soon by novel data on patients treated surgically including [neo-]adjuvant protocols). Related to the exclusively surgical aspects of gastric GIST treatment, it appears to be indicated to achieve a reduction of the, in part, surgical overtreatment using such protocols including a significant improval of the preoperative diagnostic rate in clarifying gastric GIST appropriately for an adequate therapeutic approach.
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