The impact of incidental gastrointestinal stromal tumours on patients undergoing resection of upper gastrointestinal neoplasms

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Fig. 1
Incidental gastrointestinal stromal tumours in 2 patients undergoing open 3-hole esophagectomy. (A) Preoperative computed tomography with intravenous and oral contrast revealed a soft tissue mass within the lumen of the lesser curvature of the stomach (arrow) that required an additional excision intraoperatively (patient 5). (B) A large pedunculated exophytic mass on the anterior surface of the stomach (patient 1). (C) Presence of the large gastric mass shown in panel B on the gastric conduit, requiring a wedge resection. The calibre of the gastric conduit was subsequently reduced.

Table 1

Patient demographic and clinical characteristics

Characteristic	Group; no. (%)^*		p value
Characteristic	Non-GIST	GIST	p value
No. of patients	196 (94.7)	11 (5.3)
Age, mean (range) yr	63 (22–86)	67 (30–84)	0.32
Male sex	144 (73.5)	8 (72.7)	> 0.99
Tumour location			0.71
Esophagus	78 (39.8)	5 (45.5)
Gastroesophageal junction	60 (30.6)	4 (36.4)
Stomach	58 (29.6)	2 (18.2)
Operation			0.68
Esophagectomy	137 (69.9)	9 (81.8)
Three-hole	20 (10.2)	3 (27.3)
Ivor–Lewis	60 (30.6)	5 (45.5)
Left thoracoabdominal incision	13 (6.6)	0 (0)
Left thoracotomy + laparotomy	10 (5.1)	0 (0)
Laparoscopic + thoracoscopic ± cervical	21 (10.7)	0 (0)
Transabdominal ± cervical	13 (6.6)	1 (9.1)
Gastrectomy	59 (30.1)	2 (18.2)
Proximal	2 (1.0)	0 (0)
Distal	11 (5.6)	0 (0)
Subtotal	23 (11.7)	1 (9.1)
Total	21 (10.7)	1 (9.1)
Extended total	2 (1.0)	0 (0)
Neoadjuvant therapy	72 (36.7)	4 (36.4)	> 0.99
Tumour type			0.46
Adenocarcinoma	153 (78.1)	8 (72.7)
Squamous cell carcinoma	27 (13.8)	1 (9.1)
Others	16 (8.2)	2 (18.2)
Pathological stage of primary disease			0.86
0	13 (6.6)	1 (9.1)
I	27 (13.8)	2 (18.2)
II	38 (19.4)	3 (27.3)
III	78 (39.8)	4 (36.4)
IV	40 (20.4)	1 (9.1)

Table 2

Demographic and clinical characteristics of patients in the GIST group

Patient no.	Age, sex	Primary cancer				Incidental GIST^*						Follow-up, mo	Status

		Type	Stage	Location	Operation	Time of discovery	Location	Size, cm	Mitosis/ 50 HPF	Risk	Additional procedure
1	58 M	Adenocarcinoma	II	Mid esophagus	Three-hole esophagectomy	Intraop	Stomach	1.4	2	Very low	Wedge resection	15	Deceased

2	67 M	Adenocarcinoma	IV	GEJ-II	Ivor Lewis esophagectomy	Intraop	Stomach	0.3	0	Very low	Simple excision	11	Deceased

3	69 M	Adenocarcinoma	III	GEJ-II	Ivor Lewis esophagectomy	Postop	Stomach	0.2	0	Very low	None	36	Deceased

4	84 F	Carcinoid	I	Stomach	Subtotal gastrectomy	Intraop	Stomach	0.8	0	Very low	Wedge resection	26	Deceased

5	77 M	SCC	II	Proximal esophagus	Three-hole esophagectomy	Preop	Stomach	4.0	4	Low	Wedge resection	6	Deceased

6	71 M	Adenocarcinoma	III	GEJ-II	Ivor Lewis esophagectomy	Postop	Stomach	0.6	0	Very low	None	23	Alive with disease

7	30 F	No tumour	0	Stomach	Prophylatic total gastrectomy	Postop	Stomach	0.3	0	Very low	None	11	Alive with

8	71 F	Adenocarcinoma	III	Distal esophagus	Three-hole esophagectomy, total gastrectomy	Postop	Stomach	0.1	0	Very low	None	19	Alive with disease

9	72 M	Adenocarcinoma	I	Distal esophagus	Ivor Lewis esophagectomy	Intraop	Stomach	0.7	4	Very low	Wedge resection	6	Alive with disease

						Postop	Stomach	0.2	1	Very low	None

10	70 M	Adenocarcinoma	II	GEJ-II	Transabdominal esophagectomy	Postop	Stomach	0.6	2	Very low	None	2	Alive with no disease

						Postop	Stomach	0.6	2	Very low	None

11	70 M	Adenocarcinoma	III	Distal esophagus	Ivor Lewis esophagectomy	Postop	Esophagus	0.5	1	Very low	None	5	Alive with no disease

						Postop	Esophagus	0.3	1	Very low	None

						Postop	Stomach	0.1	1	Very low	None

F = female; GEJ = gastroesophageal junction; GIST = gastrointestinal stromal tumour; HPF = high-power field; Intraop = intraoperative; M = male; Postop = postoperative; Preop = preoperative; SCC = squamous cell carcinoma.
↵* All GISTs were c-kit positive.