Transanal minimally invasive surgery for rectal gastrointestinal stromal tumor using articulated forceps after neoadjuvant chemotherapy with imatinib mesylate.

IF 0.4 Q4 ONCOLOGY

International Cancer Conference Journal Pub Date : 2025-07-24 eCollection Date: 2025-10-01 DOI:10.1007/s13691-025-00786-7

Hideyuki Masui, Yoshiro Itatani, Ryosuke Okamura, Michio Okamoto, Atsushi Yamada, Yusuke Sakamoto, Nobuaki Hoshino, Koya Hida, Kazutaka Obama

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引用次数: 0

Abstract

Rectal gastrointestinal stromal tumors (GISTs) are rare, accounting for approximately 5% of all GISTs and 0.1% of all rectal malignancies. Radical resection without capsule violation is the standard treatment for localized GISTs. However, surgical resection of large rectal GISTs poses challenges because of the narrow pelvic anatomy and the need to preserve excretory function. Based on KIT mutation status, neoadjuvant imatinib therapy facilitates tumor shrinkage and improves surgical outcomes. A 72-year-old man presented with dyschezia and hematochezia. Colonoscopy revealed a submucosal rectal tumor measuring 3 cm from the anal verge, which was diagnosed as a GIST based on biopsy findings (c-kit and DOG1 positive). Imaging studies confirmed the presence of a 5-cm tumor with significant ¹⁸F-FDG uptake. KIT mutation analysis revealed a rare exon 13 K642E mutation associated with imatinib sensitivity. Neoadjuvant imatinib therapy was administered for four months, which led to tumor shrinkage to 2.5 cm in diameter. Transanal minimally invasive surgery (TAMIS) was performed with curative intent, utilizing ArtiSential articulated forceps. Full-thickness resection was achieved without capsule violation. The patient had no postoperative complications and had retained full anal function. This case highlights the utility of a multimodal approach combining neoadjuvant imatinib therapy and TAMIS to manage large rectal GISTs. TAMIS facilitated complete tumor removal while preserving excretory function and avoiding extensive surgeries, such as total mesorectal excision. Notably, this is the first report of ArtiSential articulated forceps utilized in TAMIS, demonstrating their innovative potential in enhancing surgical precision and outcomes in challenging pelvic procedures.

Supplementary information: The online version contains supplementary material available at 10.1007/s13691-025-00786-7.

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甲磺酸伊马替尼新辅助化疗后关节钳经肛门微创治疗直肠胃肠道间质瘤。

直肠胃肠道间质瘤（gist）是罕见的，约占所有胃肠道间质瘤的5%和直肠恶性肿瘤的0.1%。根治性切除不侵犯包膜是局部gist的标准治疗方法。然而，由于骨盆狭窄的解剖结构和需要保留排泄功能，手术切除大直肠胃肠道间质瘤带来了挑战。基于KIT突变状态，新辅助伊马替尼治疗促进肿瘤缩小，改善手术效果。一名72岁男性，表现为妊高征和便血。结肠镜检查显示直肠粘膜下肿瘤，距肛门边缘3cm，根据活检结果（c-kit和DOG1阳性）诊断为GIST。影像学检查证实存在一个5厘米的肿瘤，伴有明显的18F-FDG摄取。KIT突变分析显示罕见的外显子13 K642E突变与伊马替尼敏感性相关。新辅助伊马替尼治疗4个月，肿瘤缩小至直径2.5 cm。经肛门微创手术（TAMIS）进行治疗的目的，利用艺术铰接钳。全层切除无侵犯包膜。患者无术后并发症，并保留完整的肛门功能。本病例强调了多模式联合新辅助伊马替尼治疗和TAMIS治疗大直肠胃肠道间质瘤的效用。TAMIS有助于肿瘤的完全切除，同时保留排泄功能，避免大面积手术，如全肠系膜切除。值得注意的是，这是在TAMIS中使用的人工关节钳的第一篇报道，展示了他们在提高手术精度和具有挑战性的骨盆手术结果方面的创新潜力。补充信息：在线版本包含补充资料，提供地址为10.1007/s13691-025-00786-7。

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来源期刊

International Cancer Conference Journal ONCOLOGY-

自引率

14.30%

发文量

期刊介绍： This online-only journal publishes original case reports on all types of cancer. In particular, we welcome not only case reports of educational value in the diagnosis and treatment of cancers, but also reports on molecularly analyzed cancer cases, including gene mutations, gene fusions, gene expression, and changes in copy number, regardless of their known clinical significance. Assessing the molecular analysis of a tumor usually requires a “cancer conference” in which experts from various fields discuss it. Even if the authors and their respective “cancer conference” were unable to determine the clinical significance of molecular changes at the time of submission and publication, their data may provide evidence that will help the scientific community develop precision medicine solutions in the future. We welcome case reports with reviews of the literature on similar cases, as they are more useful and valuable to readers than are reports of rare cases. International Cancer Conference Journal is the official publication of the Japan Society of Clinical Oncology (JSCO). - Presents an online-only collection of original case reports on all types of cancer - In particular, welcomes molecularly analyzed cancer cases - The Official Publication of the Japan Society of Clinical Oncology (JSCO)