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Transcoccygeal resection for a presacral GIST of the distal rectum
Goda Savulionyte1, Ronald Bleday2
1Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA g.savulionyte@gmail.com.
Abstract:
Gastrointestinal stromal tumours (GISTs) of the rectum are rare and comprise about 5% of all GISTs. Workup includes biopsy with immunohistochemistry analysis. Surgical excision is the standard treatment, although tyrosine kinase inhibitors, particularly imatinib, are known to be useful in the neoadjuvant and adjuvant settings. We present a case of a woman in her 70s who was diagnosed with distal rectal GIST. MRI revealed the tumour to be located within the presacral space. She underwent core needle biopsy with immunohistochemistry confirming KIT-positive GIST. The patient received neoadjuvant imatinib therapy, followed by surgical excision via the transcoccygeal approach (Kraske procedure). She recovered appropriately and went on to receive adjuvant imatinib therapy. We describe the progression of this patient's care and review various pertinent therapies for distal rectal GIST, highlighting the transcoccygeal resection as a safe and effective approach.
Insights
This case study discusses a rare distal rectal gastrointestinal stromal tumor (GIST). Treatment involved neoadjuvant imatinib, transcoccygeal resection, and adjuvant imatinib therapy.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Oncology
Background:
- Gastrointestinal stromal tumors (GISTs) are rare, with rectal GISTs accounting for approximately 5% of all cases.
- Diagnosis involves biopsy and immunohistochemistry, while treatment typically includes surgical excision.
- Tyrosine kinase inhibitors like imatinib are effective in neoadjuvant and adjuvant settings.
Purpose of the Study:
- To present a case of distal rectal GIST managed with a multimodal approach.
- To review current therapeutic options for rectal GIST.
- To highlight the efficacy and safety of the transcoccygeal approach for rectal GIST resection.
Main Methods:
- A case of a woman in her 70s with distal rectal GIST is presented.
- Diagnostic workup included MRI and core needle biopsy with immunohistochemistry (KIT-positive GIST).
- Treatment involved neoadjuvant imatinib, transcoccygeal resection (Kraske procedure), and adjuvant imatinib therapy.
Main Results:
- The patient successfully underwent neoadjuvant imatinib therapy and transcoccygeal resection.
- Postoperative recovery was appropriate, followed by adjuvant imatinib treatment.
- The transcoccygeal approach was demonstrated as a safe and effective surgical option.
Conclusions:
- Multimodal therapy, including neoadjuvant imatinib and surgical resection, is effective for distal rectal GIST.
- The transcoccygeal approach (Kraske procedure) offers a safe and effective surgical option for rectal GIST.
- Further research into optimal therapeutic strategies for rare rectal GISTs is warranted.
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