Partial resection of rectum for rectal GIST by posterior approach.

Objective: The standard surgical treatment for gastrointestinal stromal tumors (GISTs) is local resection. Colorectal GISTs, which account for 5-10% of all GISTs, tend to develop in the lower rectum, making transabdominal approaches both difficult and invasive. We perform partial resection of rectum by posterior approach for rectal GISTs. We herein present our surgical procedure of posterior approach and retrospectively analyze the efficacy and safety of this approach.

Methods: In this retrospective case series study from 2018 to 2023, data were collected from patients who underwent partial resection of rectum by posterior approach for rectal GIST. Patient characteristics, surgical outcomes, complications, prognosis and presence/absence of low anterior resection syndrome (LARS) were collected.

Results: Four male patients with rectal GIST were included. The median age was 50.5 years, and all patients were male. The median operation time was 203.5 min, the median intraoperative blood loss was 30 mL, and the median initial tumor diameter was 29.5 mm. One patient underwent diverting ileostomy, and the ileostomy was closed one year after surgery. Complete pathological resection was achieved in all cases. Postoperative complications were observed in one patient: outlet obstruction of the diverting ileostomy and LARS; there were no other postoperative complications including anastomotic leakage. No recurrence was observed in the median follow-up of 33.5 months.

Conclusions: This study demonstrated that posterior approach is safe, associated with a low incidence of LARS, and facilitates complete resection, making it a valuable surgical option for rectal GISTs.