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GIST: La chirurgia della malattia primaria e localizzata

GIST: La chirurgia della malattia primaria e localizzata . Fausto Catena U.O. di Chirurgia Generale, d’Urgenza e dei Trapianti Direttore Prof AD Pinna Policlinico S.Orsola- Malpighi, Università di Bologna. QUADRO CLINICO. Perforazione intestinale. Dolore addominale. diagnosi casuale.

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GIST: La chirurgia della malattia primaria e localizzata

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  1. GIST: La chirurgia della malattia primaria e localizzata Fausto Catena U.O. di Chirurgia Generale, d’Urgenza e dei Trapianti Direttore Prof AD Pinna Policlinico S.Orsola- Malpighi, Università di Bologna

  2. QUADRO CLINICO Perforazione intestinale Dolore addominale diagnosi casuale Occlusione intestinale Emorragia digestiva

  3. Fino al 50% dei pazienti si presenta con emorragia digestiva d.d. emorragie digestive

  4. DIAGNOSI STRUMENTALE TC endoscopia Indagini strumentali PET Biopsia ? Eco ultrasonografia endoscopica Rx con m.d.c.

  5. Biopsia e GIST • Rottura GIST • Dissemininazione • Emorragia • Indicata in casi di dubbi clinici (d.d. con linfoma) • Se non resecabile per la neoadiuvante

  6. IL PROBLEMA DELL’ESTEMPORANEA E DELLA FNA Cancer. 2005 Aug 29; [Epub ahead of print] The utility of fine-needle aspiration in the diagnosis of gastrointestinal stromal tumors.Elliott DD, Fanning CV, Caraway NP.

  7. TERAPIA chirurgia Terapia molecolare mirata

  8. J Surg Oncol. 2005 Jun 1;90(3):195-207; discussion 207. Gastric GI stromal tumors (GISTs): the role of surgery in the era of targeted therapy. Heinrich MC, Corless CL. • Management of gastrointestinal stromal tumors in the imatinib era: selected case studies.Oncologist. 2006 Jan;11(1):9-20 Benjamin RS, Blanke CD, Blay JY, Bonvalot S, • Eisenberg B. Ann Chir. 2005 Mar;130(3):144-51. Epub 2004 Nov 18. Surgical management of GIST in the era of GleevecBonvalot S. www.glivec.com Surg Oncol. 2005 Aug;14(2):75-84. The role of surgery in the management of gastrointestinal stromal tumors (GISTs) in the era of imatinib mesylate effectiveness.Kosmadakis N

  9. TERAPIA: razionale • Resezione radicale con margini negativi • Non vi è relezione tra estensione resezione e sopravvivenza Evans, Cancer 1985; 56: 2242- 2250

  10. Localizzazioni gastriche < 5 cm resezioni wedge Localizzazioni gastriche > 5 cm gastroresezione Lindsay J Surg Onc 1981; Wayne JD, Bell RH Jr. Surg Clin North Am. 2005 Oct;85(5):1009-20. Limited gastric resection.

  11. Linfoadenectomia Non vi è di solito coinvolgimento linfonodale NO Linfoadenectomia sistematica

  12. RESEZIONI GASTRICHE LAPAROSCOPICHE Novitsky YW, Kercher KW, Sing RF, Heniford BT. Long-term outcomes of laparoscopic resection of gastric gastrointestinal stromal tumors.Ann Surg. 2006 Jun;243(6):738-45; discussion 745-7. Catena F, Di Battista M, Fusaroli P, Ansaloni L, Di Scioscio V, Santini D, Pantaleo M, Biasco G, Caletti G, Pinna A. Laparoscopic treatment of gastric GIST: report of 21 cases and literature's review. J Gastrointest Surg. 2008 Mar;12(3):561-8. Epub 2007 Nov 27 Hindmarsh A, Koo B, Lewis MP, Rhodes M. Surg Endosc. 2005 Aug;19(8):1109-12. Epub 2005 Jun 23. Laparoscopic resection of gastric gastrointestinal stromal tumors.

  13. MARCATURA DEL GIST/ ECOGRAFIA INTRAOPERATORIA

  14. GIST DUODENO Cavallini M, Cecera A, Ciardi A, Caterino S, Ziparo V.Small periampullary duodenal gastrointestinal stromal tumor treated by local excision: report of a case. Tumori. 2005 May-Jun;91(3):264-6. De Marco G, Roviello F, Marrelli D, De Stefano A, Neri A, Rossi S, Corso G, Rampone B, Nastri G, Pinto E.A clinical case of duodenal gastrointestinal stromal tumor with a peculiarity in the surgical approach. Tumori. 2005 May-Jun;91(3):261-3 Goh BK, Chow PK, Ong HS, Wong WK.Gastrointestinal stromal tumor involving the second and third portion of the duodenum: treatment by partial duodenectomy and Roux-en-Y duodenojejunostomy. J Surg Oncol. 2005 Sep 15;91(4):273-5. Akkus MA, Kismet K, Erel S, Adibelli MA, Pulat H.Case report: duodenal stromal tumor.Acta Gastroenterol Belg. 2005 Jan-Mar;68(1):95-7. ?

  15. Resezioni segmentarie di tenue

  16. GIST ESOFAGO Dis Esophagus. 2005;18(1):70-3. Esophageal GIST: therapeutic implications of an uncommon presentation of a rare tumor.Gouveia AM, Pimenta AP, Lopes JM, Capelinha AF, Ferreira SS, Valbuena C, Oliveira MC.

  17. GIST RETTO Dis Colon Rectum. 2005 Jun;48(6):1316-9. Neoadjuvant imatinib in gastrointestinal stromal tumor of the rectum: report of a case.Lo SS, Papachristou GI, Finkelstein SD, Conroy WP, Schraut WH, Ramanathan RK.

  18. NEOADIUVANTE Gastrointest Endosc. 2005 Apr;61(4):625-7. Neoadjuvant therapy with imatinib mesylate for locally advanced GI stromal tumor.Shah JN, Sun W, Seethala RR, Livolsi VA, Fry RD, Ginsberg GG. Gan To Kagaku Ryoho. 2005 Nov;32(12):1941-4. Stomach Successfully Treated with Imatinib Mesylate Neoadjuvant Therapy and Followed Postoperatively.]Okuda H, Tanaka H, Ueno M, Shitani M, Nasuno M, Suzuki C, Nishimura S, Kimura H, Yonezawa K, Abe T, Yoshida Y, Kawabata M.

  19. CONCLUSIONI I GIST rappresentano un gruppo eterogeneo di neoplasie con terapia chirurgica particolare

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