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Annals of Surgery:
doi: 10.1097/SLA.0000000000000505
Original Article: PDF Only

Esophageal Gastrointestinal Stromal Tumor: Is Tumoral Enucleation a Viable Therapeutic Option?.

Robb, W. B. MD; Bruyere, E. MD, PhD; Amielh, D. MD; Vinatier, E. MD; Mabrut, J. Y. MD, PhD; Perniceni, T. MD; Piessen, G. MD, PhD; Mariette, Christophe MD, PhD; on-behalf-of the FREGAT Working GroupFRENCH

Published Ahead-of-Print
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Objective: The primary objective was to evaluate the feasibility of surgical enucleation of esophageal gastrointestinal stromal tumors (E-GISTs). Secondary objectives evaluated (i) the impact of tumor enucleation on oncological outcomes, (ii) the effect of pretherapeutic biopsy on the feasibility of E-GIST enucleation, and (iii) the impact of mucosal ulceration on outcome.

Background: E-GISTs are very rare tumors and esophageal resection has been the recommended approach. The feasibility and impact on outcomes of tumor enucleation are unknown.

Methods: Through a large national multicenter retrospective study, 19 patients with E-GISTs were identified between 2001 and 2010. Patients who underwent either enucleation or esophagectomy were compared.

Results: Of over 19 patients identified with E-GISTs, curative treatment was surgical for 16 patients, with enucleation in 8 and esophagectomy in 8. In the enucleation group, median tumoral diameter was 40 mm (18-65 mm), without any mucosal ulceration, preoperative capsular ruptures, or incomplete resections. In the esophagectomy group, the median tumoral diameter was 85 mm (55-250 mm), with mucosal ulceration in 4 patients, preoperative capsular rupture in 1, and no incomplete resections. Severe postoperative complication rates were 50% and 25% in the esophagectomy and enucleation groups, respectively, with 2 postoperative deaths after esophagectomy. After a median follow-up of 6.4 years, 2 recurrences were observed after esophagectomy versus 0 after enucleation. Endoscopic biopsies did not expose patients to complications or local recurrence after enucleation. Endoscopic mucosal ulceration was associated with more aggressive tumors.

Conclusions: E-GIST enucleation seems safe for tumors of less than 65 mm in diameter.

(C) 2014 by Lippincott Williams & Wilkins.


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