Dina Podolsky, MD1, Azam Qureshi, MD2, Mujjahid Abbas3, W. Scott Melvin, MD, FACS1, Diego Camacho, MD, FACS1. 1Montefiore Medical Center, 2Georgia Regents University, 3Louis Stokes VA Medical Center
Gastrointestinal stromal tumors (GISTs) represent approximately 1% of all GI tumors and are the most frequently diagnosed mesenchymal tumors of the alimentary tract. According to the Surveillance, Epidemiology, and End Result (SEER) cancer data registry, between 1993 and 2002 the incidence of GIST in the United States was 0.32 per 100, 000 people. To compare this to the incidence in the obese population, we performed a retrospective electronic medical records review on all patients undergoing laparoscopic sleeve gastrectomy for the treatment of obesity at Montefiore Medical Center.
From January 1st, 2009 to December 31st, 2013, all patients who underwent a laparoscopic sleeve gastrectomy for the treatment of obesity were included in this investigation. All patients met the criteria defined by the NIH consensus statement of 19912. All procedures were done by three surgeons (DC, JC, and PV) at the Montefiore Medical Center. A retrospective chart review was performed to determine the incidence of gastrointestinal stromal tumors in our study population. For patient’s with GIST on pathology, results of their pre-operative abdominal sonogram, demographic data, past medical history, medication lists, hospital stay, complications, and follow up were reviewed.
A total of 8 (1.1%) patients were found to have GISTs on pathology out of a total 721 patients. The majority of the GISTs were spindle type, low-grade and very-low risk, and all were benign. The average size of the tumor was 0.76 cm and all were below 2 cm. There were no post-operative complications and average hospital stay was 4 days. Two of the 8 patients required follow up surveillance with upper endoscopy, which remained negative for malignancy. Only 1 patient had a personal history of cancer (carcinoid, lung), and one patient had a family history of cancer (mother, breast). Fifty-percent were on pre-operative PPI therapy. One patient had a history of alcohol abuse and was sober for approximately 10 years at the time of surgery. Four patients had a history of smoking cigarettes although none were actively smoking at the time of surgery. Only one patient presented with pre-operative abdominal symptoms of pain and heaviness; all others were asymptomatic at time of presentation. Finally, all pre-operative abdominal sonograms were negative for any intra-abdominal pathology.
Our study found the incidence of GIST in the obese population to be more than three-times the reported incidence in the general population. This finding is limited by the fact that the incidence of GIST in the general population is most likely under-reported due to the asymptomatic and benign nature of these tumors. Nonetheless, we can conclude that when found, these tumors are likely to be small with benign characteristics, and that in this setting, a laparoscopic sleeve gastrectomy can effectively serve as a complete surgical resection of a patient’s tumor burden.