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The first 25 slides, exactly as they appear. The full deck has 60 content slides.
General Surgery
Perspective on Gastrointestinal Stromal Tumors
Built from Maingot's Abdominal Operations
What’s inside
10 sections · 60 slides
Introduction
What changed, and what did not
- Gastrointestinal stromal tumour in outline
- 12 months
- How the treatment paradigm changed
- Resected gastric stromal tumour
- Targeted molecular therapy in other solid tumours
- Relevance of the GIST experience to commoner cancers
- Tyrosine kinase inhibitors do not replace surgery
- Imatinib bound inside a tyrosine kinase
- Imatinib molecule in three dimensions
Handling the tumour at operation
Rupture, bleeding and adherent organs
- Gentle handling and tumour rupture
- Blood supply of a large stromal tumour
- Behaviour towards neighbouring organs
- Stromal tumour bulging from the small bowel wall
The stomach
The commonest site, and the operations it needs
- Regions of the stomach and duodenum
- Site and size determine the surgical approach
- Spindle cells of a stromal tumour
- Tumour growing beneath intact gastric mucosa
- Locating a gastric tumour at operation
- Two growth patterns of a gastric tumour
- Posterior wall tumours and laparoscopic exposure
- Resection margin and use of staplers
- Operating without a preoperative tissue diagnosis
- Tumours at the gastro-oesophageal junction
- Mass at the gastric cardia on computed tomography
- Massive gastric tumours and adjacent structures
- Consequence of an inseparable massive tumour
Neoadjuvant imatinib
Shrinking the tumour before operating
- Imatinib before surgery for large tumours
- Assessing response to imatinib on CT
- Timing of resection after starting a tyrosine kinase inhibitor
- Extent of resection after neoadjuvant therapy
Small intestine and duodenum
The next commonest site, and the hardest
- Small intestine as the next commonest site
- Jejunal stromal tumour on CT and at operation
- Tumours in the second part of the duodenum
- Tumours in the fourth part of the duodenum
- Reconstruction options by duodenal segment
Colon and rectum
Rare sites where sphincter preservation is the issue
- Colonic and rectal stromal tumours
- Local excision of distal rectal tumours
- 1 cm
Perioperative care
Stopping and restarting the drug
- Stopping tyrosine kinase inhibitors before surgery
- Restarting the drug after surgery
Adjuvant therapy
Who benefits after the tumour is out
- Adjuvant imatinib after resection of a localized tumour
- Patients at low risk of recurrence
- Nomogram for recurrence-free survival
- Three inputs to the nomogram
- Duration of adjuvant imatinib therapy
Surgery for metastatic disease
An unproven operation with a plausible rationale
- Standard of care for metastatic GIST
- Recurrent abdominal deposits on computed tomography
- Circled abdominal mass, axial view enlarged
- Limitations of the published evidence
- How bias inflates an apparent surgical benefit
- Rationale for resecting responding metastases
- Two arms under randomised comparison
- Detection of small-volume metastatic disease
- Mass adjacent to the stomach on computed tomography
- Practical position in the absence of randomised data
Summary
What to carry away
- Whole resected stromal tumour of the stomach
- Take-home points on surgical management
- Take-home points on drug therapy and metastases
- References
- Maingot's Abdominal Operations, 12th Edition