Gastric stromal tumours: a practical approach

Recent findings on the pathological diversity of gastric stromal tumours an d their unpredictable behaviour prompted us to review our series of 16 pati ents who had undergone surgery for these tumours from 1991 to 1998. There w ere 13 benign and 3 malignant lesions. The majority of patients presented w ith either upper gastrointestinal. bleeding or anaemia alone (12 of 16). En doscopy was an extremely useful diagnostic tool, revealing the lesion as an intraluminal protuberant tumour with or without ulcer in 10 cases and as a n ulcer alone in 4 cases, and in 1 case features suggesting an extrinsic ma ss. All the patients in the series underwent surgery. We used staplers (Autosut ureR TA 55) to excise the tumours in 7 cases, all of which on histological examination were benign with clear resection margins. Gastric resections we re performed in 5 cases for either large tumours or those situated at the f undus or antrum and local excision of the remaining 4. The mean follow-up o f these patients was 24 months. Two patients with malignant lesions died of irresectable recurrences, one 2 months and one 18 months after surgery. Th ere have been no recurrences in the tumours diagnosed as benign on histolog y. Tumour size, position and the ability to apply the stapler leaving adequ ate margin below the tumour should be the determinants of extent and type o f excision. Reliable determinants of behaviour are tumour size, grade and m itotic index.