Primary gastrointestinal sarcomas: Analysis of prognostic factors and results of surgical management

Background. This study was done to review the clinical presentation, surgic al management, and prognostic factors for primary gastrointestinal sarcomas . Methods. We reviewed medical records of 55 patients who were treated for pr imary gastrointestinal sarcomas from 1981 through 1996. Mean follow-up time was 32 months. Results. Clinical findings included gastrointestinal bleeding (51%), palpab le mass (36%), and abdominal pain (33%). The stomach was the most common si te of disease (53%), followed by the small intestine (33%). Tumors were hig h grade in 76% of patients and low-grade in 24% of patients. Complete resec tion of all gross disease was accomplished in 35 patients (64%), incomplete resection in 17 patients (31%), and biopsy only in 3 patients (5%). Adjace nt organ resection was required in 19 patients (35%). Overall actuarial sur vival was 22% (median survival, 32 months). Unfavorable prognostic factors were incomplete resection, high-grade histologic features, and tumor size o f 5 cm or more (P <.05). En bloc resection of contiguous organs did not adv ersely effect survival. In patients with complete resections, tumor grade w as the most important prognostic factor (median survival, 55 months vs 19 m onths for low-grade vs high-grade tumors; P <.05). Conclusions. Aggressive surgical resection, including en bloc resection of locally advanced tumors, appears warranted. Despite complete resections, pa tients with high-grade tumors remain at risk for recurrence.