Successful GIST Surgery at Jehangir Hospital
Mr. ABC age 67 years presented with fullness and pain in the abdomen for few months. He also had decreased appetite and weight loss. Examination revealed a large mass occupying nearly half the abdomen. He was investigated with blood tests, Ultrasonography, CT Scan, PET CT Scan and Gastroscopy all of them confirmed the diagnosis of a large tumour originating from the Stomach. The imaging revealed that the tumour was more likely to be a Gastrointestinal Stromal Tumour ( GIST ). The most appropriate treatment for such a tumour is Surgical removal with a good oncological margin and without any spill of the tumour. Since these tumours are very soft, they are likely to rupture during biopsy ( Which is usually not indicated ), handling during the removal and hence utmost care is essential.
This patient was prepared for Surgery very diligently as it was a major surgery in an elderly patient who also had diabetes, high BP and heart ailments. At surgery it was found to involve the part of Pancreas. Hence a decision was taken to remove the distal half of the pancreas and the Spleen to get a cancer negative ( Oncological ) margin. Part of the Stomach from which the tumour arose was also removed with a good margin. The surgery was accomplished successfully with care without any untoward events. The tumour measured 35 X 35 X 32 cms and weighed 3.5 kg.
Post surgery he was nursed for a few days in the ICU and then shifted to the room. He made uneventful recovery and went home after 10 days.
GIST are rare tumours comprising of less than 1 % of the tumours of the stomach. As they do not respond much to Radiotherapy and Chemotherapy, Surgical Resection is the most favoured treatment. Targeted therapy with drugs like Imatinib and Sutatinib can be used as adjunct to the surgery and in disseminated disease.