Locally advanced gastrointestinal stromal tumors: Surgical strategies and outcomes in a referral hospital in Sub-Saharan Africa

Abstract

Introduction

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract but remain rare overall. Locally advanced forms present therapeutic challenges, particularly in low-resource settings.

Methods

We conducted a descriptive cross-sectional study with retrospective data collection at the Hubert Koutoukou Maga National University Hospital Center (CNHU-HKM) in Benin. All patients with locally advanced GIST managed between January 2010 and January 2025 were included. Clinical features, management strategies and surgical outcomes were analyzed.

Results

Nine patients with locally advanced GIST were identified (male-to-female ratio 3.5:1). The stomach was the most frequent primary site (n = 5). Adjacent organ invasion involved the pancreas (n = 5), the spleen (n = 5), and the colon (n = 2). Seven patients received neoadjuvant imatinib. Seven patients underwent open surgical resection, which included en bloc removal of the primary tumor along with the involved adjacent organs or structures, in order to achieve complete (R0) resection whenever technically feasible. At last follow-up, five patients were alive (including one awaiting reoperation for local recurrence), three were lost to follow-up, and one had died.

Conclusion

This small series demonstrates the feasibility of integrating neoadjuvant therapy with surgery for locally advanced GIST in a low-resource African setting. The high rate of R0 resections achieved underscores the value of multimodal management, even in contexts where diagnosis is often delayed and therapeutic resources are limited.