| Background:Rectal gastrointestinal stromal tumors was reported as case or single-center analysis as a rare disease. The objective of the present analysis was to study the characteristic of clinical information, effect of operation and the condition of prognosis for rectal gastrointestinal stromal tumors to support clinical practice. Because of the extensive excision range and the high probability to rupture, the second object was to evaluate the safety and efficacy of laparoscopic resection (LAP) for gastric gastrointestinal stromal tumors comparing with open resection (OPEN).Methods:1. Cases from the second affiliated hospital of Zhejiang university school of medicine between 2003 and 2015 were analyzed with the clinical information of patient, pathology, treatment and prognosis to summarize the clinical characteristic of rectal gastrointestinal stromal tumors.2. The information of rectal gastrointestinal stromal tumors patients were extracted from Surveillance, Epidemiology, and End Results (SEER) database from 1973 through 2012. The characteristics of incidence, prognosis and related factors were determined applying SPSS software.3. Literatures published between January 1992 and December 2013, comparing LAP with OPEN for gastric gastrointestinal stromal tumors, were retrieved and analyzed by meta-analysis method.Results:1.10 cases were treated in the second affiliated hospital of Zhejiang university school of medicine between 2003 and 2015, both 5 cases of male and female. The median age of patients was 51 years old, and the median distance of tumor from anus was 3.25cm with median diameter of 2.7cm.8 cases underwent surgery with 4 for transanal resection and 4 for transsacral resection.1 case dropped out and 9 cases survived with 2 case recurrence by the median follow-up of 24 months. The median recurrence-free survival and overall survival time were both 24 months.2.223 cases were included from SEER database with 137 male and 86 female patients. The peak range was between 70 and 80. The median age at diagnosis was 63, and the mean diameter of tumors was 6cm, with 6.3% tumors showing far extension. The annual incidence of rectal gastrointestinal stromal tumors was 0.1525 per million, and it increased for over 2 times between 1993-2002 (0.0883/1000000) and 2003-2012 (0.2115/1000000). The prognosis of patients who were younger, underwent operation, with lower extension of tumor and diagnosed after 2003 was superior.3.16 literatures were reviewed. There was no significant difference in age, gender, tumor location, and the usage of imatinib between the two groups. LAP was superior to OPEN in blood loss, time to first flatus, time to oral intake, hospital stay after operation, overall complication with the similar prognosis in recurrence, metastasis, and recurrence-free survival.Conclusion:1. Our study is a population-based large-scale analysis for the incidence, clinical characteristics and prognosis of rectal gastrointestinal stromal tumors. The incidence improved significantly in the past decade, and the highest incidence is in the 70-80s and male. Age, level of extension and surgical treatment were independent predictors of pronosis. The operation and targeted therapy based comprehensive treatment may improved the prognosis, but the improvement still remaining to be assessed by the prospective large-sample trial2. LAP for gastric gastrointestinal stromal tumors could be safe and effective with the advantage of minimal invasiveness, faster recovery, and similar prognosis. The value of LAP remains to be assessed by Prospective randomized clinical trial. |
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