Recent Advancements in the Treatment of Rectal Gastrointestinal Stromal Tumor: In Era of Imatinib

Figures & data

Table 1 Local Resection for Rectal GISTs

Surgical Method	Year	Author	N. Patients	Rates of nIM	Duration of nIM (Month)	Tumor Size (cm)	Complication	Metastasis /Recurrence	Postop Imatanib	Distance from AV (cm)	Location
Transvaginal	2006	Hellan^Citation26	1	N	N	8	N	N	N	3	A
	2012	Hara^Citation27	1	N	N	5	N	N	N	6	A
	2019	Wang^Citation28	2	N	NA	5	N	N	Y	3	A
				N	NA	4	N	N	Y	5	A
	2021	Marta^Citation29	1	N	NA	5.1	N	N	N	2.9	A
Transsacral	2014	Sun^Citation30	2	Y	7	5/3.3^#	1	N	N	5	A
				Y	3	4.5/3.0^#	0	N	N	NA	A
	2007	Matsushima^Citation19	2	N	NA	4.1	N	N	N	5	NA
				N	NA	5.5	N	N	N	NA	A
	2008	Gervaz^Citation20	1	N	NA	6	N	N	N	NA	P
	2021	Qin^Citation21	17	Y:15^$	7	4.2	7	1	Y:14	3.3	NA
Para-sacral	2021	Matsumi^Citation23	2	Y	5	3.7/1.9^#	0	N	NA	3	A
				Y	5	9/6.4^#	1	N	NA	NA	A
	2018	Tokunaga^Citation22	2	N	N	5	N	N	NA	NA	A
				N	N	4.1	N	N	NA	NA	P
Transperineal	2010	Yanovskiy^Citation31	1	N	N	NA	N	N	NA	NA	A
	2008	Madoka^Citation32	1	Y	3	3/1.2^#	N	N	N	N	A
	2014	Kinoshita^Citation33	1	N	N	2	N	N	N	4	A
	2019	Inna^Citation24	1	N	N	NA	N	N	Y	NA	A
TAMIS	2021	Kanesada^Citation34	1	Y	3	5/3.5^#	NA	N	N	NA	NA
	2019	Spinelli^Citation35	1	Y	7	2.0/1.5^#	N	N	Y	2	NA
	2018	Spinelli^Citation9	1	N	N	4.5	N	N	Y	7	P
	2016	Pintor^Citation11	3	N	N	2.0*	N	N	N	8	NA
				N	N		N	N	N	9	NA
				N	N		N	N	N	12	NA
TEM	2021	Bai^Citation16	42	16	NA	4.41/2.46^#	4	4	Y:15^$	NA	All
	2021	Punnen^Citation15	7	N	NA	2*	2	1	Y	3.9*	All
	2018	Wu^Citation36	35	Y:12^$	6	3.1/2.6^#	NA	N	NA	4*	NA
	2017	Liu^Citation37	1	Y	12	1.9/1.5^#	N	N	Y	4	NA
	2017	Han^Citation38	25	Y:8^$	6	1.85*	N	N	Y:8^$	4.52*	All
	2019	Christopher^Citation39	1	Y	5	5.8/NA^#	N	N	Y	3	NA
TEO	2017	D’Hondt^Citation40	2	1	4	8/1.5^#	0	N	Y	2	A
				2	N	5	1	N	Y	4	A
Open surgery via anus	2020	Sun^Citation41	11	Y	7	4.0/2.0^#	1	N	N	N	NA

Notes: *Mean; ^#Tumor size after neoadjuvant imatinib; ^$Number of patient with imatinib.

Abbreviations: TEO, transanal endoscopic operation; TAMIS, transanal minimally invasive surgery; TEM, transanal endoscopic microsurgery; N, no; Y, yes; NA, unknown; A, anterior; P, posterior.

Table 2 Larger Scale Genotypes in Rectal GISTs

Year	2021	2021	2020	2020	2020	2019
Author	Yang^Citation60	Yong^Citation61	Sun^Citation41	Guo^Citation7	Nikki^Citation62	Emelia^Citation63
Number of patients	31	13	11	10	156	26
Exon11	25	11	9	9	110	23
Exon9	4	2	2	0	21	2
Exon13	0	0	0	0	5	1
PDGFR-a 12	0	0	0	1	1	0
Wild type	2	1	0	0	19	0

Abbreviation: GIST, gastrointestinal stromal tumor.

Table 3 Laparoscopic Surgery for Rectal GIST

Year	Author	Patients	Rates of nIM	Duration of nIM (Month)	Tumor Size (cm)	Complications	Metastatic or Recurrence (Yes or No)	Postopimatanib?	Distance from AV (cm)	Operation Method	Margin
2021	Nagakari^Citation70	1	Y	7	7.3/5.0^#	N	N	Y	NA	LA+ colostomy	R0
2021	Matsuzuka^Citation71	1	Y	6	NA	N	N	Y	NA	NA	R0
2020	Emoto^Citation72	1	Y	7	5.5/3.8^#	N	N	NA	2	LA+ colostomy	R0
2020	Nagano^Citation69	1	Y	8	10/7.8^#	N	N	NA	NA	LA+ colostomy	R0
2016	Somu^Citation73	1	N	N	6.7	N	N	NA	3	LA+ colostomy	NA
2016	Wachter^Citation74	1	NA	NA	10	N	N	Y	NA	LA+ colostomy	R0
2016	Kyo^Citation68	1	Y	6	8/3.7^#	N	N	NA	NA	LA+ colostomy	R0
2015	Ueki^Citation75	3	Y	NA	9/5.1^#	Y	N	NA	3	LA +colostomy	R0
			Y	NA	4.8/3.9^#	Y	N	NA	3	LA +colostomy	R0
			Y	NA	11/6.9^#	Y	N	NA	3	LA +colostomy	R0
2014	Nozawa^Citation76	1	Y	12	4.5/2.4^#	N	N	NA	2	NA	R0
2014	Yoshiya^Citation77	5	Y	NA	4.8*	N	N	NA	3.4*	LA+ colostomy	R0
2014	Piessen^Citation78	3	Y	NA	3.1/2.4^#	N	N	NA	3	NA	R0
2012	Nakamura^Citation79	1	Y	3	8/5^#	N	N	NA	NA	LA+ colostomy	R0

Note: ^#Tumor size after neoadjuvant imatinib.

Abbreviations: GIST, gastrointestinal stromal tumor; N, no; Y, yes; NA, unknown; LA, laparoscopic surgery; AV, anal verge; nIM, neoadjuvant imatinib.

Hellan M, Maker VK. Transvaginal excision of a large rectal stromal tumor: an alternative. Am J Surg. 2006;191:121–123. doi:10.1016/j.amjsurg.2005.10.013

 PubMed Web of Science ®Google Scholar

Hara M, Takayama S, Arakawa A, et al. Transvaginal resection of a rectal gastrointestinal stromal tumor. Surg Today. 2012;42:909–912. doi:10.1007/s00595-012-0215-8

 PubMed Web of Science ®Google Scholar

Shizhuo W, Nannan L, Sha N, et al. Transvaginal excision of rectal stromal tumors: case reports and a literature review. World J Surg Oncol. 2019;17:164. doi:10.1186/s12957-019-1703-8

 PubMed Web of Science ®Google Scholar

Ferreira MM, Guimaraes N, Monica IB, et al. Transvaginal resection of a rectal gastrointestinal stromal tumor: a case report. J Med Cases. 2021;12:57–60. doi:10.14740/jmc3615

 PubMedGoogle Scholar

Sun LF, He JJ, Yu S-J, et al. Transsacral excision with pre-operative imatinib mesylate treatment and approach for gastrointestinal stromal tumors in the rectum: a report of two cases. Oncol Lett. 2014;8:1455–1460. doi:10.3892/ol.2014.2406

 PubMed Web of Science ®Google Scholar

Matsushima K, Kayo M. Transsacral approach to resect a gastrointestinal stromal tumor in the rectum: report of two cases. Surg Today. 2007;37:698–701. doi:10.1007/s00595-006-3466-4

 PubMed Web of Science ®Google Scholar

Gervaz P, Huber O, Bucher P, Sappino P, Morel P. Trans-sacral (Kraske) approach for gastrointestinal stromal tumour of the lower rectum: old procedure for a new disease. Colorectal Dis. 2008;10:951–952. doi:10.1111/j.1463-1318.2008.01489.x

 PubMed Web of Science ®Google Scholar

Qin X, Li C, Yang Z, et al. Transsacrococcygeal approach in rectal gastrointestinal stromal tumour resection: 10-year experience at a single centre. Ann Transl Med. 2021;9:341. doi:10.21037/atm-20-8204

 PubMed Web of Science ®Google Scholar

Matsumi Y, Hamada M, Sakaguchi T, Sekimoto M, Kurokawa H, Kinoshita H. Para-sacral approach followed by laparoscopic low anterior resection of a gastrointestinal stromal tumour at the anterior wall of the lower rectum. Colorectal Dis. 2021;23:1579–1583. doi:10.1111/codi.15597

 PubMed Web of Science ®Google Scholar

Tokunaga R, Sakamoto Y, Nakagawa S, et al. Para-sacral approach for large gastrointestinal stromal tumor of the lower rectum. Int Cancer Conf J. 2018;7:40–42. doi:10.1007/s13691-017-0314-x

 PubMed Web of Science ®Google Scholar

Yanovskiy M, Saddig C, Ommer A, Pahnke JM, Kröpfl D. [Gastrointestinal stromal tumor (GIST) of the anterior rectal wall. R0 resection with simultaneous radical retropubic prostatectomy]. Der Urologe. 2010;49:271–274. German. doi:10.1007/s00120-009-2186-y

 Web of Science ®Google Scholar

Hamada M, Ozaki K, Horimi T, et al. Recurrent rectal GIST resected successfully after preoperative chemotherapy with imatinib mesylate. Int J Clin Oncol. 2008;13:355–360. doi:10.1007/s10147-007-0735-1

 PubMed Web of Science ®Google Scholar

Kinoshita H, Sakata Y, Umano Y, Iwamoto H, Mori K. Perineal approach for a gastrointestinal stromal tumor on the anterior wall of the lower rectum. World J Surg Oncol. 2014;12:62. doi:10.1186/1477-7819-12-62

 PubMed Web of Science ®Google Scholar

Tulina I, Kitsenko Y, Lukyano A, Bergamaschi R, Tsarkov P. Transperineal Excision of Rectal Gastrointestinal Stromal Tumor. Surg Technol Int. 2019;34:195–198.

 PubMedGoogle Scholar

Kanesada K, et al. [A case of gastrointestinal stromal tumor of the lower rectum that enabled minimally invasive surgery with imatinib mesylate as neoadjuvant chemotherapy]. Gan To Kagaku Ryoho. 2021;48:269–272. Japanese.

 PubMedGoogle Scholar

Spinelli A, Carvello M, Sacchi M, et al. Transanal minimally invasive surgery (TAMIS) for anterior rectal GIST. Tech Coloproctol. 2019;23:501–502. doi:10.1007/s10151-019-01979-y

 PubMed Web of Science ®Google Scholar

Nepal P, Mori S, Kita Y, et al. Management of a case of high-risk gastrointestinal stromal tumor in rectum by transanal minimal invasive surgery. World J Surg Oncol. 2018;16:165. doi:10.1186/s12957-018-1463-x

 PubMed Web of Science ®Google Scholar

Pintor-Tortolero J, García JC, Cantero R. Transanal minimally invasive surgery approach for rectal GIST. Tech Coloproctol. 2016;20:321–322. doi:10.1007/s10151-016-1438-2

 PubMed Web of Science ®Google Scholar

Bai X, Zhou W, Li Y, Lin G. Transanal endoscopic microsurgery with alternative neoadjuvant imatinib for localized rectal gastrointestinal stromal tumor: a single center experience with long-term surveillance. Surgical endoscopy. 2021;35:3607–3617. doi:10.1007/s00464-020-07837-5

 PubMed Web of Science ®Google Scholar

Punnen S, Karimuddin AA, Raval MJ, Phang PT, Brown CJ. Transanal Endoscopic Microsurgery (TEM) for rectal GI stromal tumor. J Surg Oncol. 2021;221:183–186. doi:10.1002/jso.2562110.1016/j.amjsurg.2020.07.013

 Google Scholar

Wu X, Lin G, Qiu H, Zhou J, Xu J. [Transanal endoscopic microsurgery for local excision of rectal gastrointestinal stromal tumors]. Zhonghua wei Chang Wai Ke Za Zhi. 2018;21:1296–1300. Chinese.

 PubMedGoogle Scholar

Liu Q, Zhong G, Zhou W, Lin G. Initial application of transanal endoscopic microsurgery for high-risk lower rectal gastrointestinal stromal tumor after imatinib mesylate neoadjuvant chemotherapy: a case report. Medicine. 2017;96:e7538. doi:10.1097/md.0000000000007538

 PubMed Web of Science ®Google Scholar

Han X, Xu J, Qiu H, Lin G. A novel curative treatment strategy for patients with lower grade rectal gastrointestinal stromal tumor: chemoreduction combined with transanal endoscopic microsurgery. J Laparoendosc Adv Surg Tech A. 2017;27:579–585. doi:10.1089/lap.2017.0051

 PubMed Web of Science ®Google Scholar

Kane WJ, Friel CM. Diagnosis and treatment of rectal gastrointestinal stromal tumors. Dis Colon Rectum. 2019;62:537–540. doi:10.1097/dcr.0000000000001376

 PubMed Web of Science ®Google Scholar

D’Hondt M, Yoshihara E, Dedrye L, et al. Transanal endoscopic operation for benign rectal lesions and T1 carcinoma. J Soc Laparoendosc Surg. 2017;21. doi:10.4293/jsls.2016.00093

 PubMed Web of Science ®Google Scholar

Sun Q, Su N, Li X, Hu Z, Wang W. Open transanal resection of low rectal stromal tumor following neoadjuvant therapy of imatinib mesylate: report of 11 cases and review of literature. Asia Pac J Clin Oncol. 2020;16:123–128. doi:10.1016/j.amjsurg.2020.07.01310.1111/ajco.13292

 PubMed Web of Science ®Google Scholar

Yang W, Liu Q, Lin G. The effect of neoadjuvant imatinib therapy on outcome and survival in rectal gastrointestinal stromal tumors: a multiinstitutional study. J Surg Oncol. 2021;124(7):1128–1135. doi:10.1002/jso.26628

 PubMed Web of Science ®Google Scholar

Yong ZZ, et al. Neoadjuvant tyrosine kinase inhibitors in rectal gastrointestinal stromal tumours: a provision for enhanced oncological and functional outcomes. Int J Clin Oncol. 2021;26:913–921. doi:10.1007/s10147-021-01867-2

 PubMed Web of Science ®Google Scholar

Guo W, Yang Z, Wei Y, et al. Radical excision versus local resection for primary rectal gastrointestinal stromal tumors cohort study. Int J Surg. 2020;77:190–197. doi:10.1016/j.ijsu.2020.03.068

 PubMed Web of Science ®Google Scholar

IJzerman NS, Mohammadi M, Tzanis D, et al. Quality of treatment and surgical approach for rectal gastrointestinal stromal tumour (GIST) in a large European cohort. Eur j Surg Oncol. 2020;46:1124–1130. doi:10.1016/j.ejso.2020.02.033

 PubMed Web of Science ®Google Scholar

Tatsuoka T, et al. Frequent rectal gastrointestinal stromal tumor recurrences in the imatinib era: retrospective analysis of an International Patient Registry. World J Surg Oncol. 2019;120:715–721. doi:10.1186/s12957-017-1231-310.1002/jso.25621

 Google Scholar

Nagakari K, Matoba S, Toda S, et al. Hybrid resection of massive rectal gastrointestinal stromal tumor using laparoscopic and transanal approaches. Asian J Endosc Surg. 2021;14:102–105. doi:10.1111/ases.12824

 PubMed Web of Science ®Google Scholar

Matsuzuka S, et al. [A case of the large rectal GIST treated by laparoscopic anus preserving operation after neoadjuvant therapy with imatinib mesylate]. Gan To Kagaku Ryoho. 2021;48:385–387. Japanese.

 PubMedGoogle Scholar

Emoto S, Akiyoshi T, Fukata K, Nagasaki T, Fukunaga Y. Laparoscopic transabdominal dissection and transection of the distal rectum followed by local excision through the anus for rectal gastrointestinal stromal tumor. Dis Colon Rectum. 2020;63:e542. doi:10.1097/dcr.0000000000001814

 PubMed Web of Science ®Google Scholar

Nagano S, Miyoshi N, Takahashi T, et al. Preoperative imatinib and laparoscopic intersphincteric resection for large rectal gastrointestinal stromal tumor: a case report. Int J Surg Case Rep. 2020;71:235–239. doi:10.1016/j.ijscr.2020.05.031

 PubMed Web of Science ®Google Scholar

Somu K, Dashore AR, Shah AR, Anandh R. Laparoscopic excision of large lower rectal gastrointestinal stromal tumour (GIST): a case report. J Minim Access Surg. 2016;12:283–285. doi:10.4103/0972-9941.181311

 PubMed Web of Science ®Google Scholar

Wachter N, Wörns M-A, Dos Santos D, et al. Transanal minimally invasive surgery (TAMIS) approach for large juxta-anal gastrointestinal stromal tumour. J Minim Access Surg. 2016;12:289–291. doi:10.4103/0972-9941.181306

 PubMed Web of Science ®Google Scholar

Kyo K, Azuma M, Okamoto K, et al. Neoadjuvant imatinib treatment and laparoscopic anus-preserving surgery for a large gastrointestinal stromal tumor of the rectum. World J Surg Oncol. 2016;14:68. doi:10.1186/s12957-016-0837-1

 PubMed Web of Science ®Google Scholar

Ueki T, Nagayoshi K, Manabe T, et al. Laparoscopic en bloc excision of gastrointestinal stromal tumors of the rectum after neoadjuvant imatinib therapy: anteriorly extended intersphincteric resection combined with partial resection of the prostate. Tech Coloproctol. 2015;19:247–251. doi:10.1007/s10151-014-1261-6

 PubMed Web of Science ®Google Scholar

Nozawa H, Kanazawa T, Tanaka T, et al. Laparoscopic resection of a gastrointestinal stromal tumor of the lower rectum in a patient with coronary artery disease following long-term neoadjuvant imatinib treatment and anticoagulation therapy. World J Surg Oncol. 2014;12:211. doi:10.1186/1477-7819-12-211

 PubMed Web of Science ®Google Scholar

Fujimoto Y, Akiyoshi T, Konishi T, et al. Laparoscopic sphincter-preserving surgery (intersphincteric resection) after neoadjuvant imatinib treatment for gastrointestinal stromal tumor (GIST) of the rectum. Int J Colorectal Dis. 2014;29:111–116. doi:10.1007/s00384-013-1769-7

 PubMed Web of Science ®Google Scholar

Piessen G, et al. Laparoscopic local excision and rectoanal anastomosis for rectal gastrointestinal stromal tumor: modified laparoscopic intersphincteric resection technique. J Surg Oncol. 2014;57:900–904. doi:10.1002/jso.2621510.1097/dcr.0000000000000146

 Google Scholar

Nakamura T, Mitomi H, Onozato W, et al. Laparoscopic resection of a gastrointestinal stromal tumor of the rectum after treatment with imatinib mesylate: report of a case. Surg Today. 2012;42:1096–1099. doi:10.1007/s00595-012-0134-8

 PubMed Web of Science ®Google Scholar