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Video

Session: Ongoing Videos

VM60 - Abdominoperineal resection for rectal gastrointestinal stromal tumor

ONGOING VIDEOS
Location: ASCRS Connect Lounge, Hall B1/B2, Ground Level

    Video Presentation(s)

  • Cristina Botero Fonnegra, MD (she/her/hers)

    Resident Physician
    BayCare Health System
    Tampa, FL, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • KK

    Karishma Kodia, MD

    Fellow
    Washington University in St. Louis
    SAINT LOUIS, Missouri, United States

    Disclosure information not submitted.

  • Talia R. Arcieri, MD

    General Surgery Resident/Post-Doctoral Research Fellow
    University of Miami Miller School of Medicine
    Miami, Florida, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • LF

    Luanne Force, MD

    Faculty
    University of Miami
    Miami, Florida, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Cristina Botero Fonnegra, MD: This individual has no financial relationships with ineligible companies.
Talia R. Arcieri, MD: This individual has no financial relationships with ineligible companies.
Luanne Force, MD: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Gastrointestinal stromal tumors (GIST) arise from the interstitial cells of Cajal and are associated with a KIT mutation in 80% of cases. Fewer than 5% of cases arise in the rectum, which is the rarest location for GIST tumors. Among rectal tumors, only 0.1% are GIST in origin. Treatment typically includes imatinib (Gleevac) followed by surgical resection. In this case video, we present a case of rectal GIST that ultimately required surgical resection with robotic APR.

Methods/Interventions: An 81-year-old female initially presented with rectal bleeding. CT abdomen and pelvis with IV contrast demonstrated a 12 x 8.5 x 10.2 cm lobulated mass centered in the vaginal canal with anterior rectal wall involvement. On flexible sigmoidoscopy, a submucosal, non-obstructing large mass was noted in the distal rectum extending to the rectosigmoid junction, involving one-third of the luminal circumference. Pathology demonstrated a gastrointestinal stromal tumor, spindle cell type without mitoses, and KIT mutation in exon 11. The patient was started on imatinib. CT imaging seven months after neoadjuvant therapy demonstrated a decrease in the size of the lesion to 7.3 x 6.2 x 9.8 cm. The patient was discussed at our multidisciplinary tumor board, and the decision was made to proceed with operative management.

The patient was taken to the operating room for a robotic-assisted rectal GIST excision and consented for possible abdominoperineal resection (APR). During the anterior rectal wall tumor dissection, it was evident that the distal rectal wall was too thin to dissect away from the GIST, and the decision was made to proceed with an APR.

Results/Outcomes: The patient recovered well postoperatively and was discharged home on POD 7. Final pathology demonstrated a
8.5cm GIST, positive radial margins (necrotic tumor), 10% viable tumor.

The patient’s postoperative course was uncomplicated. She was seen in the clinic, continued imatinib, and continued to do well.

Conclusion/Discussion: Abdominoperineal resection may be necessary for complete resection of large rectal gastrointestinal stromal tumors.