The True Incidence of Gastric GIST: an Update

The True Incidence of Gastric GIST: an Update Obesity Surgery (2018) 28:1787 https://doi.org/10.1007/s11695-018-3235-7 LETTER TO EDITOR/LED REPLY 1 1 Jonathan B. Yuval & Ram Elazary Published online: 29 April 2018 Springer Science+Business Media, LLC, part of Springer Nature 2018 Gastrointestinal stromal tumor (GIST) is a rare neoplasm of asymptomatic GISTs are rarely diagnosed in the general the alimentary tract with an incidence of around 1 per 100,000 population. These tumors are particularly common in [1]. The most common location is in the stomach where 60% older patients and special attention must be given when of these tumors occur [2]. Incidence in the stomach is there- performing LSG on them. It is important to examine the fore 6 per 1,000,000. specimen macroscopically and actively seek these tumors. Laparoscopic sleeve gastrectomy (LSG) provides patho- If thorough macroscopic examination is performed micro- logical specimens of the majority of the stomach. Therefore, scopic evaluation may be of little added value in most patients undergoing LSG are an advantageous cohort for cases [4]. The malignant potential and risk of recurrence studying the incidence of GIST. of the vast majority of these resected tumors is extremely A previous published report from our registry described an low according to accepted nomograms [5]. Although the incidence of 0.6% for GIST in the stomach in this population, management of GIST smaller than 2 cm is controversial, it which was 1000 times more common than the accepted inci- seems these patients do not require special oncological dence in the literature [3]. follow up after LSG. Since that report we have frequently encountered GIST during LSG, perhaps due to increased awareness. A new search of our registry showed that 1052 patients underwent Compliance with Ethical Standards LSG between 2007 and 2016. Eleven patients had GIST in Conflict of Interest The authors declare that they have no conflicts of their resected stomach, an incidence of more than 1%. This interest. incidence is 66% higher even than our previous report. The group of patients with GIST had lower BMI and older age compared to the control group. There were no statistically References significant differences in comorbidities. Tumor size ranged between 2 and 28 mm with a mean size of 9 mm. All tumors 1. Nilsson B, Bümming P, Meis-Kindblom JM, et al. Gastrointestinal had low mitotic index. Laparoscopic sleeve gastrectomy was stromal tumors: the incidence, prevalence, clinical course, and prog- completed in all patients, sometimes with mild deviation from nostication in the preimatinib mesylate era—a population-based the standard technique. study in western Sweden. Cancer. 2005;103(4):821–9. 2. DeMatteo RP, Lewis JJ, Leung D, et al. Two hundred gastrointestinal GISTs are found more and more commonly in metabol- stromal tumors: recurrence patterns and prognostic factors for sur- ic surgery across the world. This may be due to an asso- vival. Ann Surg. 2000;23(1):51–8. ciation between these tumors and obesity, or because 3. Yuval JB, Khalaileh A, Abu-Gazala M, et al. The true incidence of gastric GIST-a study based on morbidly obese patients undergoing sleeve gastrectomy. Obes Surg. 2014;24(12):2134–7. https://doi.org/ 10.1007/s11695-014-1336-5. * Jonathan B. Yuval 4. Kopach P, Genega EM, Shah SN, et al. The significance of histologic jyuval@hadassah.org.il examination of gastrectomy specimens: a clinicopathologic study of 511 cases. Surg Obes Relat Dis. 2017;13(3):463–7. https://doi.org/ Ram Elazary 10.1016/j.soard.2016.11.011. ramelazary@hadassah.org.il 5. Gold JS, Gönen M, Gutiérrez A, et al. Development and validation of a prognostic nomogram for recurrence-free survival after complete surgical resection of localised primary gastrointestinal stromal tu- Department of General Surgery, Hadassah-Hebrew University mour: a retrospective analysis. Lancet Oncol. 2009;10(11):1045– Medical Center, Kyriat Hadassah, P.O. Box 12000, 52. https://doi.org/10.1016/S1470-2045(09)70242-6. 91120 Jerusalem, Israel http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Obesity Surgery Springer Journals

The True Incidence of Gastric GIST: an Update

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Springer US
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Copyright © 2018 by Springer Science+Business Media, LLC, part of Springer Nature
Subject
Medicine & Public Health; Surgery
ISSN
0960-8923
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1708-0428
D.O.I.
10.1007/s11695-018-3235-7
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Abstract

Obesity Surgery (2018) 28:1787 https://doi.org/10.1007/s11695-018-3235-7 LETTER TO EDITOR/LED REPLY 1 1 Jonathan B. Yuval & Ram Elazary Published online: 29 April 2018 Springer Science+Business Media, LLC, part of Springer Nature 2018 Gastrointestinal stromal tumor (GIST) is a rare neoplasm of asymptomatic GISTs are rarely diagnosed in the general the alimentary tract with an incidence of around 1 per 100,000 population. These tumors are particularly common in [1]. The most common location is in the stomach where 60% older patients and special attention must be given when of these tumors occur [2]. Incidence in the stomach is there- performing LSG on them. It is important to examine the fore 6 per 1,000,000. specimen macroscopically and actively seek these tumors. Laparoscopic sleeve gastrectomy (LSG) provides patho- If thorough macroscopic examination is performed micro- logical specimens of the majority of the stomach. Therefore, scopic evaluation may be of little added value in most patients undergoing LSG are an advantageous cohort for cases [4]. The malignant potential and risk of recurrence studying the incidence of GIST. of the vast majority of these resected tumors is extremely A previous published report from our registry described an low according to accepted nomograms [5]. Although the incidence of 0.6% for GIST in the stomach in this population, management of GIST smaller than 2 cm is controversial, it which was 1000 times more common than the accepted inci- seems these patients do not require special oncological dence in the literature [3]. follow up after LSG. Since that report we have frequently encountered GIST during LSG, perhaps due to increased awareness. A new search of our registry showed that 1052 patients underwent Compliance with Ethical Standards LSG between 2007 and 2016. Eleven patients had GIST in Conflict of Interest The authors declare that they have no conflicts of their resected stomach, an incidence of more than 1%. This interest. incidence is 66% higher even than our previous report. The group of patients with GIST had lower BMI and older age compared to the control group. There were no statistically References significant differences in comorbidities. Tumor size ranged between 2 and 28 mm with a mean size of 9 mm. All tumors 1. Nilsson B, Bümming P, Meis-Kindblom JM, et al. Gastrointestinal had low mitotic index. Laparoscopic sleeve gastrectomy was stromal tumors: the incidence, prevalence, clinical course, and prog- completed in all patients, sometimes with mild deviation from nostication in the preimatinib mesylate era—a population-based the standard technique. study in western Sweden. Cancer. 2005;103(4):821–9. 2. DeMatteo RP, Lewis JJ, Leung D, et al. Two hundred gastrointestinal GISTs are found more and more commonly in metabol- stromal tumors: recurrence patterns and prognostic factors for sur- ic surgery across the world. This may be due to an asso- vival. Ann Surg. 2000;23(1):51–8. ciation between these tumors and obesity, or because 3. Yuval JB, Khalaileh A, Abu-Gazala M, et al. The true incidence of gastric GIST-a study based on morbidly obese patients undergoing sleeve gastrectomy. Obes Surg. 2014;24(12):2134–7. https://doi.org/ 10.1007/s11695-014-1336-5. * Jonathan B. Yuval 4. Kopach P, Genega EM, Shah SN, et al. The significance of histologic jyuval@hadassah.org.il examination of gastrectomy specimens: a clinicopathologic study of 511 cases. Surg Obes Relat Dis. 2017;13(3):463–7. https://doi.org/ Ram Elazary 10.1016/j.soard.2016.11.011. ramelazary@hadassah.org.il 5. Gold JS, Gönen M, Gutiérrez A, et al. Development and validation of a prognostic nomogram for recurrence-free survival after complete surgical resection of localised primary gastrointestinal stromal tu- Department of General Surgery, Hadassah-Hebrew University mour: a retrospective analysis. Lancet Oncol. 2009;10(11):1045– Medical Center, Kyriat Hadassah, P.O. Box 12000, 52. https://doi.org/10.1016/S1470-2045(09)70242-6. 91120 Jerusalem, Israel

Journal

Obesity SurgerySpringer Journals

Published: Apr 29, 2018

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