| ObjectiveTransanal Endoscopic Microsurgery(TEM)was invented by Professor Gerhard Beuss of Germany.With a set of well designed proctoscopy system,the surgeon can perform various operations in laparoscopic surgery in the dilated intestine.TEM improves the surgical quality of local resection of rectal lesions,and has many advantages such as less invasiveness,lower risk,shorter hospital stay,and less postoperative complications.TEM has been used to treat Gastrointestinal stromal tumors(GIST)in previous studies.In this study,clinical data and postoperative outcomes(hospitalization time,quality of life,recurrence rate,metastasis rate and prognosis)of patients with rectal GIST were analyzed to investigate the clinical efficacy of TEM in the treatment of rectal GIST.MethodsThe patients who were diagnosed as rectal GIST by pathological examination after TEM treatment in gastrointestinal surgery department at Qianfoshan Hospital of Shandong Province from January 2008 to October 2017 were retrospectively analyzed for their sex,age of onset,and clinical manifestations.Preoperative examination,size and location of tumors,application of targeted drugs,TEM procedures,surgical complications and postoperative pathological findings,postoperative quality of life,recurrence and metastasis,and relapse free survival(RFS)and overall survival(OS)and other parameters.Statistical analysis of relevant data.ResultsA total of 15 patients were included in the study,including 11 males(73%)and 4 females(27%).The age of onset ranged from 33 to 72 years,with an average age of 56.2±10.9 years and a median age of 59 years.Rectal GIST were mostly found on the anterior wall of the rectum in the middle and lower segments.The primary manifestations included blood of fecal and bowel habits changes(mainly due to difficulty in defecation).Five patients were treated with imatinib,a targeted drug.The treatment period was 2-12 months,and the average treatment period was6.75±4.3 months.During the treatment,pelvic MRI was performed to evaluate the therapeutic effect.All the 15 patients underwent TEM.The operation was successful.A small amount of bleeding occurred during the operation.The average blood loss was 9.6 ±4.3 ml.The average operation time was 48.8 ± 10.1 minutes.The average hospital stay was 8.2 ± 3.5 days after surgery.No serious intraoperative complications and conversion to open surgery happened.Statistical analysis(t-test)with relevant literature data showed significant differences in blood loss and operation time(p<0.05),and there was no statistical difference in hospitalization time(p>0.05).According to the National Institutes of Health(National Institutes of Health NIH)improved classification criteria for invasiveness risk of GIST in 2008,15 patients underwent TEM surgery in this study were rated for tumor risk,there were 3 cases classified with Very Low Risk,5 cases with Low Risk,4 cases with Intermediate Risk,and 3 cases with High Risk.All patients showed pathological complete resection of the lesions without involvement of the resected plane;CD117(+)was found in 14 cases;CD34(+)was 13;CD117(+)and CD34(+)were 12 cases.Postoperative bleeding(5.8%)occurred in 1 case 1 week after surgery.After conservative treatment,the patient was recovered and discharged;postoperative pulmonary infection with Acute Respiratory Distress Syndrome(ARDS)occurred in 1 patient 2 days after surgery,and he was discharged after active conservative treatment.The median follow-up time was 61 months after surgery.All cases survived so far.One patient(NO.1)experienced local recurrence 108 months after surgery and was subjected to TEM resection.Bone metastasis occurred 55 months later in 1 patient(NO.6),median OS was 62 months,median RFS was 55 months.Fifteen patients had no significant changes in their anal function and urinary function before surgery.ConclusionTEM can be used tfor local resection of rectal GIST with low and moderate risk.In the treatment of rectal stromal tumors,TEM surgery reduced intraoperative bleeding,shortened the operation time,and reduced postoperative hospital stay days.No significant effect on postoperative anal function and voiding function.Preoperative using of imatinib can effectively increase the rate of local resection in patients with advanced diseases.Under the premise of ensuring negative margins,they all achieved complete resection of the lesions without serious surgical complications.This study also found that all patients with rectal GIST had positive expressions of CD117 and/or CD34 and DOG1 detected by immunohistochemistry,indicating that a more accurate diagnosis can be obtained in clinical practice by detecting CD117,CD34,DOG1,and other biomarkers. |
PDF Full Text Request