Surgical treatment for gastric leiomyosarcoma

Gastric leiomyosarcoma is an uncommon disease, and the optimal treatment has not been established. In order to better define the optimal surgical treatment, we retrospectively analyzed our experience with these tumors.

Records of 103 patients, who underwent surgery between 1972 and 1997 were reviewed.

The upper third of stomach was the most frequent site of disease (66 cases). Seventy one tumors were smaller than 50 mm. Forty patients had ulcerated tumors. Twenty nine of 33 tumors had an inhomogeneous pattern on endoscopic ultrasonography. Nodal involvement was not observed in our series. The most common surgery was wedge resection, performed in 68 patients. The 5-year disease-specific survival rate after curative resection was 93.0% overall, 87.5% after gastrectomy, and 95.0% after wedge resection. 5 year survival rate was worse in patients with ulcer than those without ulcer (87.1% vs. 96.3%, p < 0.01). No patient with a tumor smaller than 3 cm died from the disease. The dominant mode of recurrence was liver and peritoneal metastasis. No lymph node recurrence was observed.

Surgery is indicated for tumors larger than 3 cm, with rapid growth, with inhomogeneous US pattern, or with ulceration. Wedge resection is the preferred treatment.