Trans-sacral (Kraske) approach for gastrointestinal stromal tumour of the lower rectum: old procedure for a new disease
Trans-sacral (Kraske) approach for gastrointestinal stromal tumour of the lower rectum: old procedure for a new disease
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DOI：
10.1111/j.1463-1318.2008.01489.x
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发表时间：
2008-11-01
影响因子：
3.4
通讯作者：
Morel, P.
中科院分区：
文献类型：
--
作者：
Gervaz, P.;Huber, O.;Morel, P.
直肠下段胃肠道间质瘤(GIST)是一种罕见的间叶性肿瘤，其特点是：1)局部区域淋巴结无转移；2)有与肠腔相反的生长趋势。因此，直肠腺癌的两种首选手术入路(即经腹和经肛门)不适合GIST，原因是：1)全直肠系膜切除无用；2)经肛门入路难以定位肿瘤。我们在此报告一例巨大的直肠下段胃肠道间质瘤，并成功地采用后路经骶骨入路进行治疗。低位直肠GIST是Kraske手术的良好指征，这一相对较新的疾病实体可能有助于将旧手术重新引入21世纪结直肠外科医生的医疗室。
Gastrointestinal stromal tumours (GISTs) of the lower rectum are rare cancers from mesenchymatous origin, which are characterized by; 1) the absence of metastases in loco-regional lymph nodes; and 2) a tendency to grow opposite to the intestinal lumen. Thus, the two preferred surgical approaches for rectal adenocarcinomas (i.e. abdominal and transanal) are inappropriate for GISTs, due to: 1) the uselessness of total mesorectal excision; and 2) to the difficulty to locate the tumour with a transanal approach. We report here a case of a large GIST of the lower rectum which was successfully treated with a posterior trans-sacral approach. Lower rectum GISTs are good indications for the Kraske procedure, and this relatively new disease entity may contribute to the reintroduction of an old procedure into the armamentarium of 21(st) century colorectal surgeons.