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OBJECTIVE: Of gastrointestinal stromal tumors (GIST), esophageal GIST is extremely rare neoplasm, arising from mesodermal tissue in esophagus. Although new chemotherapic agents have been emerged, radical surgical removal is still one of optimal treatment. Among various approach methods, we tried to perform video-assisted thoracoscopic mass removal, excluding a large sized mass. Here, we reviewed long term surgical results of patients with esophageal GIST.
METHODS: From January 2002 to June 2008, six patients (two male and four female, mean age 54.3±14.7 years, range 34-71) diagnosed with esophageal GIST in our hospital underwent surgical resection, excluding one patient who had a concomitant malignancy. All patients’ data, tumor characteristics, surgical procedure and recurrence data were analyzed retrospectively.
RESULTS: Of them, three patents had preoperative significant symptom, two patients had tumor size > 3cm diameter, one patient was suffered from increasing mass size and two were already suspicious of GIST under preoperative endoscopic ultrasound. The location of tumors were three cases in upper thoracic, two in mid-thoracic and one in lower thoracic esophagus. All patients underwent macroscopically complete surgical resection: video-assisted thoracoscopic surgery (VATS) for five patients and thoracotomy for one; right-side approach for five patients and left-side approach for one. The mean tumor size was 4.6±1.8cm (range 2.8-7.9cm). Base on National Institutes of Health (NIH) consensus classification system, tumors were identified as an intermediate risk of malignant potential for five (83.3%) and low risk for one (16.7%). There were no perioperative mortality, complication and recurrence during long-term follow-up (mean follow-up 52 months, range 37-60 months).
CONCLUSIONS: Although surgical resection of esophageal GIST remains mainstay of treatment, macroscopically complete surgical resection using VATS, especially in suspicious low malignant risk esophageal GIST, could be a feasible choice and make better chance for long-term free-recurrence.