Gastrointestinale Stromatumoren (GIST)

Excited-state electronic properties, structural studies, noncovalent interactions, and inhibition of the novel severe acute respiratory syndrome coronavirus 2 proteins in Ripretinib by first-principle simulations

Ripretinib is a recently developed drug for the treatment of adults with advanced gastrointestinal stromal tumors. This paper reports an attempt to study this molecule by electronic modeling and molecular mechanics to determine its composition and other specific chemical features via the density-functional theory (DFT), thereby affording sufficient information on the electronic properties and descriptors that can enable the estimation of its molecular bioactivity. We explored most of the physico-chemical properties of the molecule, as well as its stabilization, via the studies of the natural bond orbitals and noncovalent interactions. The electronic excitation, which is a time-dependent process, was examined by the time-dependent DFT with a CAM-B3LYP functional. The molecular docking study indicated that Ripretinib strongly docks with three known novel severe acute respiratory syndrome coronavirus 2 (SARS-n-CoV-2) proteins with a reasonably good docking score.

Laparoscopic resection of locally advanced gastrointestinal stromal tumour (GIST) of the stomach following neoadjuvant imatinib chemoreduction

INTRODUCTION

Laparoscopic resection of locally advanced gastrointestinal stromal tumours (GISTs) is rarely offered to patients as a first line of treatment.

PRESENTATION OF CASES

We present two cases of locally advanced gastric GISTs successfully treated with neoadjuvant imatinib and followed up by complete laparoscopic excision of the residual tumour mass. There was no evidence of local recurrence or distant metastases after a mean follow up of more than 40 months.

DISCUSSION

Over the last decade, the development of imatinib has totally revolutionized management of metastatic GISTs and it is now possible to achieve primary tumour downstaging of more than 80%. Unfortunately, current literature on laparoscopic excision of locally advanced gastric GISTs following neoadjuvant treatment of imatinib remains scarce. The present cases strongly suggest that this new therapeutic approach might become the preferred medical option in such clinical situation.

CONCLUSION

Patients with locally advanced non-metastatic gastric GISTs should be offered first-line neoadjuvant. Imatinib-based cytoreductive chemotherapy as an alternative to radical debulking surgery, as a substantial proportion of them will experience significant tumour shrinkage and therefore benefit from a much less invasive laparoscopic approach.

Surgical treatment of GIST--an institutional experience of a high-volume center

BACKGROUND

Discovery of the molecular pathogenesis of Gastrointestinal stromal tumors led to the development of targeted therapies, revolutionizing their treatment. However, surgery is still the mainstay of GIST therapy and the only chance for cure.

AIM

Here we present a single institutional consecutive case series of 159 GIST-patients.

METHODS AND PATIENTS

A total of 159 GIST-patients who underwent resection between 1994 and 2011 were reviewed for clinicopathohistological data, informations on surgical and medical therapy and further follow-up, outcome and survival data.

RESULTS

Laparoscopic (25.2%) and open (71.1%) GIST surgery achieved complete resection rates of 97.5% and 85.2%, whereas 44.4% of incomplete and 6.6% of complete resected patients died from GIST. Compared to open surgery laparoscopy significantly reduced duration of operation (183.4 vs. 130.6 min), length of hospitalization (16.1 vs. 8.3 d) and morbidity (23% vs. 7.5%). Mean survival time was 3.7 ± 2.7 years (R0: 5.1 a and R1: 2.6 a) and the mean overall survival was 4.5 ± 3.8 years.

CONCLUSION

Complete surgical resection is the primary goal and laparoscopy can be performed safely in a subset of GIST-patients with potential perioperative advantages. Although not proven by the present study the authors assume that multimodal GIST-treatment, as performed in reference-centers, is required for advanced or high risk disease. Our data suggest the potential for minimally invasive GIST resection to achieving comparable oncological outcomes as after open surgery while providing low morbidity rates.

Laparoscopically assisted resections of small bowel stromal tumors are safe and effective

OBJECTIVE

To compare the efficacy of laparoscopically assisted and open resections in treatment of small bowel stromal tumors (SBST).

METHODS

A retrospective study of 85 patients who underwent curative resections for SBST (38 by laparoscopically assisted procedures and 47 by open procedures) was performed.

RESULTS

There were no differences between open and laparoscopically assisted approaches in terms of patients' age, gender, presenting symptoms, histological risk or extent of resection (P > 0.05). The median tumor size for laparoscopically assisted resections was 4.0 cm (range 1.2-7.0 cm), which was the same as that for the open resections (range 2.0-10.0 cm). There were fewer complications in the laparoscopic group than those in the open resection group (7.9% vs 17.0%), but no significant difference was observed (P > 0.05). The 2-year survival of the two patient groups was almost the same (86.8% vs 89.4%). Laparoscopically assisted procedures required on average 22.5 min less of operating time (87.5 min vs 110.0 min, P = 0.006), 1.0 day less of bowel recovery time (3.0 days vs 4.0 days, P = 0.001) and 5.0 days less in hospital stay (8.0 days vs 13.0 days, P < 0.001).

CONCLUSION

Laparoscopically assisted resection of SBST is a safe alternative to open resection.

Surgical treatment of gastric and small bowel gastrointestinal stromal tumours

AIM

This study aimed to evaluate a set of gastrointestinal stromal tumours (GIST) of the stomach and the small bowel managed with a laparoscopic technique.

MATERIAL AND METHODS

The study covers a period from January 1, 2007 until June 1, 2010 during which 13 patients underwent the laparoscopic removal of stomach tumours and 2 patients underwent the removal of a small bowel GIST in the General Hospital in Pardubice. In all cases tumours were removed in a laparoscopic way, including the healthy border of the stomach tissue.

RESULTS

No death was observed in our study. Two patients suffered from wound infection (secondary healing), one of them requiring repeat surgery owing to the excessive narrowing of the distal part of the stomach. Dehiscence of laparoscopic sutures or other intra-abdominal complications were not observed. During monitoring all patients were free of signs of local recurrence, but tumour progression into the liver was observed in 1 patient. Gastrointestinal stromal tumours are very rare tumours but their incidence is increasing. At this time the consensus about the necessity of preoperative unambiguous differentiation between malignant or less malignant variants is not available. Strict differentiation is very difficult and the decision whether to choose a more radical surgical approach for more malignant variants is not clear-cut.

CONCLUSIONS

In cases of gastric and small bowel GISTs the local removal of a tumour with the healthy border of the stomach tissue may be chosen as an adequate approach. Our results support this local surgical approach.

Cyclin H expression is increased in GIST with very-high risk of malignancy

BACKGROUND

Risk estimation of gastrointestinal stromal tumours (GIST) is based on tumour size and mitotic rate according to the National Institutes of Health consensus classification. The indication for adjuvant treatment of patients with high risk GIST after R0 resection with small molecule inhibitors is still a controversial issue, since these patients represent a highly heterogeneous population. Therefore, additional prognostic indicators are needed. Here, we evaluated the prognostic value of cyclin H expression in GIST.

METHODS

In order to identify prognostic factors of GIST we evaluated a single centre cohort of ninety-five GIST patients. First, GISTs were classified with regard to tumour size, mitotic rate and localisation according to the NIH consensus and to three additional suggested risk classifications. Second, Cyclin H expression was analysed.

RESULTS

Of ninety-five patients with GIST (53 female/42 male; median age: 66.78a; range 17-94a) risk classification revealed: 42% high risk, 20% intermediate risk, 23% low risk and 15% very low risk GIST. In patients with high risk GIST, the expression of cyclin H was highly predictive for reduced disease-specific survival (p = 0.038). A combination of cyclin H expression level and high risk classification yielded the strongest prognostic indicator for disease-specific and disease-free survival (p < or = 0.001). Moreover, in patients with tumour recurrence and/or metastases, cyclin H positivity was significantly associated with reduced disease-specific survival (p = 0.016) regardless of risk-classification.

CONCLUSION

Our data suggest that, in addition to high risk classification, cyclin H expression might be an indicator for "very-high risk" GIST.

[Surgical therapy of abdominal and trunk soft tissue sarcomas]

Soft tissue sarcomas are rare tumours of mesenchymal cells which can arise in all parts of the body. Sarcomas of the trunk and abdominal cavity are a very heterogeneous group of tumours. This review focuses on retroperitoneal sarcomas, which tend to be asymptomatic for a long time, resulting in an advanced stage at presentation in most patients. Surgical resection is the basis for cure in these patients, possibly combined with radiation. In contrast to extremity sarcomas, the majority of patients with retroperitoneal sarcomas succumb to an isolated local recurrence of the disease. In case of local recurrence or distant metastases, surgical resection should again be contemplated.

[Surgical treatment of gastrointestinal stromal tumors]

Interdisciplinary management is required in the therapy of gastrointestinal stromal tumors, in consideration of complex strategies in the treatment of patients with GIST. Endoscopy, histopathology - mutation analysis included - but also radio diagnostic, surgery and oncology are topics in treating patients suffering from GIST. Especially in cases of advanced gastrointestinal stromal tumor or metastatic disease our multidisciplinary knowledge is required, because information about these entities are rather rare.