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Stromal sarcoma of the stomach: therapeutic considerations
P Piso1, H J Schlitt, J Klempnauer
1Klinik für Viszeral- und Transplantationschirurgie, Zentrum Chirurgie, Medizinische Hochschule Hannover, Germany.
Objective:
To present our experience of the surgical treatment of primary gastric stromal sarcomas and to compare it with reported results.
Design:
Retrospective study.
Setting:
University hospital, Germany.
Subjects:
17 patients (13 men and 4 women, median age: 58 years) who were operated on for stromal sarcomas of the stomach from April 1987 to March 1999.
Main Outcome Measures:
Extent of resection, morbidity and mortality, histopathological features, survival.
Results:
Stromal sarcomas made up 0.8% of all gastric malignancies. Abdominal pain and gastrointestinal bleeding were the main symptoms. 16/17 were resected succesfully. The main type of resection was total gastrectomy (n = 11, in 6 cases as extended gastrectomy), followed by wide local excision of the stomach wall (n = 4), and proximal gastrectomy (n = 1). Of all resections 10 were radical (R0) and 6 were palliative (R1/R2). 5 patients developed complications. One patient died postoperatively. Median tumour size was 70 mm (range 30-230). The serosa was penetrated in 11 cases, lymph node metastases were found in 3 patients, and distant metastases in 8. Overall median survival was 19 months (2-64) and 5 patients survived 5 years. After radical resection (n = 10) median survival was 39 months (2-64) and the above mentioned 5 patients survived 5 years.
Conclusion:
Stromal sarcomas of the stomach are rare, the resection rate is high and the type of resection varies with the extent of the tumour. Wide local excision may be sufficiently radical. Long-term results after radical resection seem to be better than those after gastric adenocarcinoma.