Transanal endoscopic microsurgery (TEM) for rectal GI stromal tumour

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Gastroenterology

Background:

• Rectal gastrointestinal stromal tumours (GIST) present unique surgical challenges due to pelvic anatomy.
• Radical surgery for rectal GIST often compromises anal sphincter function.
• Transanal endoscopic microsurgery (TEM/TEO) enables precise excision and potential organ preservation.

Purpose of the Study:

• To evaluate the efficacy and outcomes of TEM/TEO for rectal GIST.
• To assess the feasibility of organ preservation and R0 resection in rectal GIST.
• To investigate the role of tumour size and neoadjuvant imatinib in rectal GIST treatment.

Main Methods:

• Retrospective single-centre study of consecutive patients undergoing TEM/TEO for rectal GIST (2007-2023).
• Analysis of clinicopathological data, operative outcomes, and postoperative course.
• Kaplan-Meier estimation for disease-free survival (DFS) and overall survival (OS).

Main Results:

• 13 patients with rectal GIST treated with TEM/TEO.
• High R0 resection rate (92.3%) achieved with organ preservation.
• Median follow-up of 60 months showed 15.4% local recurrence and 7.7% mortality.

Conclusions:

• TEM/TEO is effective for achieving R0 resection and organ preservation in rectal GIST.
• Tumour size should not preclude local excision if R0 resection is technically feasible.
• Neoadjuvant imatinib may aid local excision in select cases; further multicentre studies are needed.