We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Correspondence |

Open or Laparoscopic Resection of a Large Gastric Gastrointestinal Stromal Tumor

Tetsuji Fujita, MD
Arch Surg. 2009;144(2):193-197. doi:10.1001/archsurg.2008.538.
Text Size: A A A
Published online


I read with interest the article by Huguet and colleagues1 on sophisticated laparoscopic operations for gastric gastrointestinal stromal tumors (GISTs) and their outcomes. The authors report their excellent outcomes of attempted laparoscopic surgery for gastric GIST, including a low rate of conversion to open laparotomy (6%), a minimum morbidity rate (9%), no perioperative mortality, a short median hospital stay (3 days), and no evidence for tumor recurrence during a mean follow-up of 13 months in 33 patients. Based on these findings, the authors concluded that almost all gastric GISTs are amenable to laparoscopic resection without compromising oncologic principles. The authors classified 26 small (<5 cm) GISTs as having low malignant potential, 5 GISTs (5-10 cm or having 5-10 mitoses per high power field) as being intermediate-malignant, and 2 GISTs (measuring >10 cm or having >10 mitoses per high power field) as having high malignant potential (as shown in Table 2). This suggests that at least 26 tumors were smaller than 5 cm, whereas Table 1 indicates that 25 tumors were smaller than 5 cm, yielding a confusion. As tumor size is an established independent prognostic factor and correlates with mitotic index, which is also an independent determinant for recurrence, I would like to know the correct distribution of tumor size and ask the authors how long the patients who had gastric GISTs larger than 5 cm were followed up. Approximately half of the patients with primary GISTs who undergo gross complete resection will experience tumor recurrence, and the reported median time to recurrence after radical surgery ranges from 18 to 24 months.2 Gastric GISTs, accounting for 50% to 60% of all GISTs, have a more favorable clinical course than small intestinal GISTs after resection. In a large retrospective study that included 74 gastric GISTs, 35 small intestinal GISTs, 14 colorectal GISTs, and 4 other GISTs, patients with small intestinal GISTs did worse than those with gastric GISTs (hazard ratio, 3.3) on multivariate analysis after adjustment for tumor size and mitotic activity.3 In that study, the authors reported recurrence-free survivals of approximately 90% at 1 year and 80% at 2 years after radical open surgery. Small gastric GISTs with low mitotic activity rarely recur, while up to 86% of gastric GISTs larger than 10 cm with high mitotic activity recur during a long-term follow-up.4 In the current study, I think that a mean follow-up of 13 months is too short to correctly evaluate the oncologic outcomes of laparoscopic surgery, especially in patients with large gastric GISTs.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles