Letters To The Editor
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World J Gastroenterol. Mar 28, 2013; 19(12): 2009-2010
Published online Mar 28, 2013. doi: 10.3748/wjg.v19.i12.2009
Tumor rupture during surgery for gastrointestinal stromal tumors: Pay attention!
Nadia Peparini, Piero Chirletti
Nadia Peparini, Azienda Sanitaria Locale Roma H, 00043 Ciampino, Italy
Piero Chirletti, Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy
Author contributions: Peparini N conceived and drafted the manuscript, critically revised the manuscript and gave the final approval; Chirletti P critically revised the manuscript and gave its final approval.
Correspondence to: Nadia Peparini, MD, PhD, Azienda Sanitaria Locale Roma H, Via Mario Calò, 5-00043 Ciampino, Italy. nadiapeparini@yahoo.it
Telephone: +39-339-2203940 Fax: +39-76-488423
Received: December 24, 2012
Revised: February 18, 2013
Accepted: March 6, 2013
Published online: March 28, 2013
Processing time: 96 Days and 13.1 Hours

In a recently published letter to the editor, we debated the proposal by Coccolini et al to treat gastrointestinal stromal tumors (GISTs) of the esophagogastric junction with enucleation and, if indicated, adjuvant therapy. We highlighted that, because the prognostic impact of a T1 high-mitotic rate esophageal GIST is worse than that of a T1 high-mitotic rate gastric GIST, enucleation may not be adequate surgery for esophagogastric GISTs with a high mitotic rate. In rebuttal, Coccolini et al pointed out the possible bias in assessment of the mitotic rates due to the lack of standardized methods and underlined that the site and features of the tumor need to be carefully considered in evaluation of the risk-benefit balance. Here we confirm that, apart from the problematic issue of mitotic counting, enucleation should not be indicated for GISTs at any site to reduce the risk of tumor rupture, which has been recently considered to be an unfavorable prognostic factor, and to avoid microscopic residual tumor.

Keywords: Gastrointestinal stromal tumor, Esophagogastric junction, Surgery, Resection, Enucleation