Related Experiment Video
Updated: May 17, 2026
Laparoscopy-endoscopy Cooperative Surgery for the Treatment of Gastric Gastrointestinal Stromal Tumors
Published on: February 19, 2022
Surgical second-look in high risk gastrointestinal stromal tumor of small intestine: A case report
Margherita Nannini1, Maria Abbondanza Pantaleo, Fausto Catena
1Department of Hematology and Oncology Sciences "L.A. Seragnoli", S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Introduction:
The peritoneum is one of the most common sites of distant gastrointestinal stromal tumor (GIST) metastases. In particular, GIST arising from the small intestine with resected minimal synchronous macroscopic peritoneal carcinomatosis or with primary tumor rupture has a higher risk of developing peritoneal recurrence. Current clinical practice does not envisage second-look surgery in GIST patients at high risk of developing peritoneal recurrence, and no literature data are available.
Presentation Of Case:
We describe a 45-year-old woman who underwent emergency surgical resection of jejunal GIST presenting with spontaneous tumor rupture, synchronous ovarian and minimal macroscopic peritoneal involvement, and subsequent second-look surgery after 13 months of imatinib treatment.
Discussion:
Second-look surgery confirmed a 2.6cm lesion close to the mesenteric border of the fourth jejunal loop, and 11 peritoneal lesions with a macroscopic necrotic aspect related to treatment response. After conversion to an open procedure, a segmental jejunal resection was performed with removal of all peritoneal lesions and macroscopic radical cytoreduction.
Conclusion:
Second-look surgery in selected GIST patients may be performed after at least 12 months of medical treatment with tyrosine-kinase inhibitors to identify those patients with limited peritoneal disease not disclosed by instrumental imaging who could undergo radical cytoreduction of peritoneal lesions.
Insights
Second-look surgery can identify limited peritoneal disease in select gastrointestinal stromal tumor (GIST) patients after tyrosine-kinase inhibitor treatment. This approach may enable radical cytoreduction for patients with peritoneal metastases not detected by imaging.
Area of Science:
- Oncology
- Gastroenterology
- Surgical Oncology
Background:
- Peritoneal metastases are common in gastrointestinal stromal tumors (GIST).
- High-risk GIST patients, especially those with small intestine origin, primary tumor rupture, or peritoneal carcinomatosis, face increased recurrence risk.
- Current GIST management lacks guidelines for second-look surgery in high-risk patients.
Purpose of the Study:
- To evaluate the utility of second-look surgery in a GIST patient with peritoneal metastases after neoadjuvant therapy.
- To assess the feasibility of radical cytoreduction for peritoneal GIST lesions identified during second-look surgery.
Main Methods:
- Case report of a 45-year-old woman with jejunal GIST, spontaneous rupture, and peritoneal involvement.
- Neoadjuvant imatinib treatment for 13 months.
- Second-look surgery to assess peritoneal disease and perform cytoreduction.
Main Results:
- Second-look surgery revealed a jejunal lesion and 11 peritoneal lesions with necrotic changes, indicating treatment response.
- Macroscopic radical cytoreduction was achieved through segmental jejunal resection and removal of all peritoneal lesions.
- The patient's peritoneal lesions were not fully disclosed by instrumental imaging prior to surgery.
Conclusions:
- Second-look surgery can be beneficial in selected GIST patients after tyrosine-kinase inhibitor therapy.
- It aids in identifying limited peritoneal disease not evident on imaging.
- This strategy may allow for radical cytoreduction of peritoneal lesions in carefully selected GIST patients.
