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Japanese Journal of Clinical Oncology Advance Access published online on May 31, 2005
Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hyi091
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© 2005 Foundation for Promotion of Cancer Research
Received January 7, 2005
Accepted April 17, 2005

Original Article

Surgery Including Liver Resection for Metastatic Gastrointestinal Stromal Tumors or Gastrointestinal Leiomyosarcomas

Souya Nunobe 1, Tsuyoshi Sano 1*, Kazuaki Shimada 1, Yoshihiro Sakamoto 1, and Tomoo Kosuge 1

1 Department of Surgery, National Cancer Center, Tokyo, Japan

* To whom correspondence should be addressed.
Tsuyoshi Sano, E-mail: tsano{at}ncc.go.jp


  Abstract

Background: In recent years, imatinib mesylate (STI 571), a tyrosine kinase inhibitor, has shown short-term clinical usefulness for gastrointestinal stromal tumor or gastrointestinal leiomyosarcoma (GIST). The value of surgical resection, including hepatectomy, for metastatic GIST remains unknown. Our aim was to evaluate the outcome of surgical resection, including hepatectomy, for metastatic GIST at a single institute.

Methods: Eighteen patients who underwent hepatectomy for metastatic GIST were identified and the clinicopathological data of these patients were analyzed retrospectively.

Results: The primary site of GIST included stomach in 10, duodenum in five, ileum in two and esophagus in one patient. A hemihepatectomy or greater resection was undertaken in eight patients. Six patients underwent simultaneous resection for primary and hepatic desease. There was no in-hospital mortality in this series. The post-hepatectomy 3- and 5-year survival rates were 63.7 and 34.0% respectively, with a median of 36 (17-227) months. Recurrence after the initial hepatectomy was documented in 17 patients (94%), and metastatic mass of the remnant liver developed in 15 of these 17 patients (88%). Three patients survived >5 years after the initial hepatectomy who underwent multiple surgical resections during this period. No clinicopathological characteristic was a significant predictive factor for survival.

Conclusions: Multiple surgical resections, including hepatectomy, may contribute to important palliation in selected patients with metastatic GIST. Surgical cure seems to be difficult due to the high frequency of repeat metastasis to various sites. Therefore, adjuvant therapy must be required in the treatment of metastatic GIST.

Keywords: gastrointestinal stromal tumor; liver metastasis; hepatectomy.
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