Oncological Results for the Surgical Treatment of Rectal Gastrointestinal Stromal Tumor

直腸的胃腸間質腫瘤在腫瘤外科之治療成果

張東晟(Tung-Cheng Chang) ； 梁金銅(Jin-Tung Liang) ； 林本仁(Ben-Ren Lin) ； 黃約翰(John Huang)

《中華民國大腸直腸外科醫學會雜誌》 20卷4期 (2009/12) Pp. 87-93

https://doi.org/10.6312/SCRSTW.2009.20(4).09811

摘要

目的　直腸的原發性胃腸間質腫瘤是很少見的，且對於其臨床病理的認知也並不多。本研究爲調查並分析其在單一醫學中心之治療的成果，及其臨床表徵和治療的預後。
方法　以回溯性之方法從1990年至2007年，將所有在本院有接受外科手術治療的原發性直腸胃腸間質腫瘤，調查並分析其病人之特性、腫瘤大小、腫瘤位置、臨床症狀、手術方法、術後治療及術後存活。
結果　總共有十個病人接受外科的治療，這裡面有九個爲男性。年齡之中位數爲57歲（範圍：38-82歲），追蹤時間的中位數爲23個月（範圍：4至107月)。其最主要的臨床表徵爲裡急後重、下消化道出血及腹部可觸摸到腫瘤。腫瘤大小的平均爲9.3公分（範圍：3.2至15cm)。所有的病人其五年存活率爲38.1%，而接受腫瘤完全切除的病人其五年腫瘤非復發之存活爲21.4%(p=0.24)。接受腫瘤完全切除的病人其五年存活率爲42.9%，而未完全切除的病人爲零。腫瘤大於等於10公分的病人其五年存活爲零而小於10公分的病人爲60%(p=0.006)。
結論　直腸胃腸間質腫瘤其主要症狀和一般的直腸腫瘤相似，是以裡急後重和下消化道出血來表現。腫瘤是否大於10公分對於預後是一個很重要的因子。直腸胃腸間質腫瘤的治療是以腫瘤完全切除爲主，如果有轉移其治療原則也盡可能將轉移切除，未來期待在術前化療能對其整體治療有所幫助。

關鍵字

胃腸間質腫瘤 ； 臨床病理 ； 直腸

並列摘要

Purpose. Primary gastrointestinal stromal tumor (GIST) of the rectum is rare and its clinico-pathology is not well understood. This study investigated the clinical characteristic of rectal GIST treated in a single institute.
Methods. From January 1990 to December 2007, medical records in our institute were reviewed and patients who underwent surgery for rectal GIST were identified. Their demographic features, tumor size, tumor location, clinical symptoms, operation methods, adjuvant treatment, recurrence, and survival were investigated and analyzed.
Results. Of the ten rectal GIST cases identified, nine were males. The median age at the time of diagnosis was 57 years (range: 38-82) and the median survival time was 23 months (range from 4 to 107 months). The major symptoms as an initial presentation were tenesmus, lower GI bleeding and palpable abdominal mass. The mean size of tumor was 9.3cm (range: 3.2 to 15cm). The overall 5-year survival rate was 38.1% and 5-year disease free survival rate in patients of complete resection was 21.4%. The five-year survival rate is 0% in non-curative resection patients and 42.9% in curative resection patient (p=0.24). The five years survival rate is 0% in patients with tumor≥10cm and 60% in patients with tumor＜10cm. (p=0.006)
Conclusion. The most common symptoms of rectal GIST are tenesmus and lower GI bleeding, which are similar to those of other kinds of rectal tumors. The tumor size≥10cm is a risk factor of prognosis in rectal GIST. The appropriate treatment for rectal GIST is complete resection without residual tumors, with complete removal of metastases even in patients with recurrence. Future studies should focus on neo-adjuvant treatment strategies.

並列關鍵字

Gastrointestinal stromal tumor ； Clinicopathology ； Rectum