The Role of the Surgeon in Multidisciplinary Approach to Gastrointestinal Stromal Tumors

摘要: Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal neoplasms of digestive tract with an estimated annual incidence 10–20 cases per one million inhabitants (H. Joensuu et al;2002, B. Nilsson, al; 2005). GISTs probably arise from precursor cells interstitial Cajal. Their defining characteristic is a gain-offunction mutation in genes coding for KIT tyrosine kinase receptor, which considered driving force cell proliferation this tumour(Y. Shinomura al;2005) tumors usually appear patients above 50 years age, whereas maximum observed 5th and 6th decade life. The mean age at diagnosis 55–63 years(Tran T It very rare children affects males females equally. GIST mainly disease GI tract, mesentery, omentum. Most commonly, it originates stomach (60%), followed by small intestine (30%), colon rectum (5%), oesophagus (5%) (Van Der Zwan SM, al;2005). Fletcher al. proposed classification aggressive behaviour based on their diameter mitotic rate(C. D. M. al;2002). factors were both shown to predict recurrence survival(S. Singer R. P. DeMatteo al;2000). can present many ways. Thirty percent diagnosed incidentally pathological or autopsy resection specimen(B. Small may be asymptomatic grow large size before producing any symptoms. symptomatic larger than 5 cm maximal dimension. Symptoms presentation include abdominal pain, mass, nausea, vomiting, anorexia, weight loss. vast majority metastatic located intraabdominal, either liver, omentum, peritoneal cavity(C. Metastatic spread lymph nodes other regions via lymphatics rare. bleding due mucosal ulceration symptom(Gold JS al ; 2006). Mitotic count tumor have been important. A study examined 1765 prognostic markers(Miettinen 2005 ). Tumours less 10