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Modern treatment of gastric gastrointestinal stromal tumors

World Journal of Gastroenterology 2012年第46期18卷 6720-6728页

作者： kevin k roggin Mitchell C Posner Department of Surgery Pritzker School of Medicine University of Chicago

Gastrointestinal stromal tumors (GIST) are rare mesenchymal smooth muscle sarcomas that can arise anywhere within the gastrointestinal tract. Sporadic mutations within the tyrosine kinase receptors of the interstitial cells of Cajal have been identified as the key molecular step in GIST carcinogenesis. Although many patients are asymptomatic, the most common associated symptoms include: abdominal pain, dyspepsia, gastric outlet obstruction, and anorexia. Rarely, GIST can perforate causing life-threatening hemoperitoneum. Most are ultimately diagnosed on cross-sectional imaging studies (i.e., computed tomography and/or magnetic resonance imaging in combination with upper endoscopy. Endoscopic ultrasonographic localization of these tumors within the smooth muscle layer and acquisition of neoplastic spindle cells harboring mutations in the c-kIT gene is pathognomonic. Curative treatment requires a complete gross resection of the tumor. Both open and minimally invasive operations have been shown to reduce recurrence rates and improve long-term survival. While there is considerable debate over whether GIST can be benign neoplasms, we believe that all GIST have malignant potential, but vary in their propensity to recur after resection and metastasize to distant organ sites. Prognostic factors include location, size (i.e., > 5 cm), grade (> 5-10 mitoses per 50 high power fields and specific mutational events that are still being defined. Adjuvant therapy with tyrosine kinase inhibitors, such as imatinib mesylate, has been shown to reduce the risk of recurrence after one year of therapy. Treatment of locally-advanced or borderline resectable gastric GIST with neoadjuvant imatinib has been shown to induce regression in a minority of patients and stabilization in the majority of cases. This treatment strategy potentially reduces the need for more extensive surgical resections and increases the number of patients eligible for curative therapy. The modern surgical treatment of

关键词： Gastrointestinal stromal tumors Laparoscopic resections of gastrointestinal stromal tumors Imatinib mesylate Gastrectomy

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The impact of sarcopenia on patients undergoing treatment for pancreatic ductal adenocarcinoma

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Journal of Pancreatology 2020年第2期3卷 59-71页

作者： Amundson Julia R. Williams Jelani k. Benjamin Andrew J. Witmer Hunter D.D. roggin kevin k. Department of Surgery University of Chicago Medical CenterChicagoILUSA

Introduction:Pancreatic ductal adenocarcinoma(PDAC)is a deadly cancer that disproportionately affects geriatric *** therapy with surgery and chemotherapy is associated with longer survival than medical treatment or supportive *** selection of patients for surgical treatment,based on patient-specific factors such as sarcopenia,may help risk-stratify patients and improve *** paper aims to review the current literature on the impact of sarcopenia and sarcopenic obesity on patients undergoing treatment for ***:The impact of sarcopenia and sarcopenia obesity on perioperative and long-term outcomes after treatment for PDAC is *** has been associated with high-grade complications,longer length of hospital,and intensive care unit stays,more frequent discharge to skilled nursing facilities and decreased utilization of adjuvant therapy in patients treated with curative intent *** obesity has been associated with more complications,high-grade complications,and hematologic *** with sarcopenic obesity may have even lower overall survival than sarcopenic ***:The effect of a pre-treatment diagnosis of sarcopenia or sarcopenic obesity on outcomes for patients undergoing treatment for PDAC remains unknown,in part due to the heterogeneity of studies and *** programs including resistance exercise and nutritional supplementation have shown benefit in sarcopenic ***:PDAC remains a deadly disease and patient-specific factors such as sarcopenia and sarcopenic obesity identified at the time of cancer diagnosis offer potential as risk stratification measures and points of ***,a paucity of standardized measurement tools,definitions,and prehabilitation regimens limits the clinical implementation of such knowledge.

关键词： Frailty Pancreatic ductal adenocarcinoma Sarcopenia

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