5 years Experience in the Treatment of GIST Tumors in the Virgen Macarena University Hospital

Introduction: Gastrointestinal stromal tumors (GIST) are the most common and diagnosed mesenchymal tumors. Its most frequent location is the stomach, and although they are very heterogeneous, most of them present mutations for the KIT receptor or for the platelet-derived growth factor receptor PDGRA. Even so, the clinical manifestations will depend mostly on their location and size, without being GIST identifying characteristics. This great variability makes it difficult to elaborate diagnostic protocols, as well as guidelines and universal treatment algorithms. Thus, they are usually diagnosed accidentally during the study of other pathologies. The main difference with other gastrointestinal neoplasms is the impossibility of predicting GIST malignancy based on the histopathological study, which is also limited to a submucosal location of the lesion. In addition, we also find great variability at the macroscopic level, which complicates the preoperative assessment by imaging. It seems that the malignant potential resides in the inherent characteristics of the tumor and not so much in its progression, which explains the need in some patients for prolonged treatment even after the tumor has been removed. Even so, the gold standard treatment in GIST is surgical resection, although, thanks to the mutations that they present, target therapies with inhibitors of the tyrosine kinase receptors in advanced and metastatic GISTs can be used. Objective of the study: To know the results in safety and efficacy of the surgical treatment of GIST, as well as to establish the comparative between open and laparoscopic approach, and to analyze the coincidences with the literature. Materials and methods: We collected 40 cases of GIST diagnosed and operated by the General Surgery Service at the Virgen Macarena University Hospital (Seville) in the last four years (2012-2016), where age, sex, tumor location and surgical factors are analyzed. Results: The mean age of the patients was 58.76 years, with the median being 60 years, with 51.43% women (18) of 57.56 years on average, and 48.57% men (17). ), of 60.2 years on average. There are the same number of cases located in the stomach as in the small intestine (15 patients, 42.86%), followed by colon, (5.71%), pancreas (5.71%) and greater omentum (2.86%)., among which there are 5 cases of recurrence. 80% of the cases (28) were operated on by open surgery, and of all the interventions, 91.43% were performed by specialist physicians and 8.57% by medical residents. A 8.57% of the cases had to be reoperated urgently by open approach, with postoperative complications appearing in 5.71%. Discussion: Comparing our results with the literature regarding the diagnosis and therapeutic management of GIST tumors collected in our series. Conclusion: The results collected in this study conform to the most significant publications, despite the small sample size. The morbidity of surgical treatment can be considered minimal, and the protocol, safe. The comparison between laparoscopy and open surgery does not influence the stay of patients but is more beneficial in terms of the appearance of complications. However, our study is limited by the absence of prognostic data.