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World J Gastrointest Surg. Aug 27, 2023; 15(8): 1559-1563
Published online Aug 27, 2023. doi: 10.4240/wjgs.v15.i8.1559
Impact of tumour rupture risk on the oncological rationale for the surgical treatment choice of gastrointestinal stromal tumours
Nadia Peparini
Nadia Peparini, Azienda Sanitaria Locale Roma 6, Ciampino, Rome 00043, Italy
Author contributions: Peparini N conceived and performed research, analized data, wrote and revised the manuscript and gave the final approval.
Conflict-of-interest statement: The author reported no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nadia Peparini, MD, PhD, Azienda Sanitaria Locale Roma 6, Distretto 3, Via Mario Calò 5, Ciampino, Rome 00043, Italy. nadiapeparini@yahoo.it
Received: December 23, 2022
Peer-review started: December 23, 2022
First decision: January 9, 2023
Revised: January 25, 2023
Accepted: June 19, 2023
Article in press: June 19, 2023
Published online: August 27, 2023
Abstract

Tumour rupture of gastrointestinal stromal tumours (GISTs) has been considered to be a remarkable risk factor because of its unfavourable impact on the oncological outcome. Although tumour rupture has not yet been included in the current tumor-node-metastasis classification of GISTs as a prognostic factor, it may change the natural history of a low-risk GIST to a high-risk GIST. Originally, tumour rupture was defined as the spillage or fracture of a tumour into a body cavity, but recently, new definitions have been proposed. These definitions distinguished from the prognostic point of view between the major defects of tumour integrity, which are considered tumour rupture, and the minor defects of tumour integrity, which are not considered tumour rupture. Moreover, it has been demonstrated that the risk of disease recurrence in R1 patients is largely modulated by the presence of tumour rupture. Therefore, after excluding tumour rupture, R1 may not be an unfavourable prognostic factor for GISTs. Additionally, after the standard adjuvant treatment of imatinib for GIST with rupture, a high recurrence rate persists. This review highlights the prognostic value of tumour rupture in GISTs and emphasizes the need to carefully take into account and minimize the risk of tumour rupture when choosing surgical strategies for GISTs.

Keywords: Gastrointestinal stromal tumours, Tumour rupture, Residual tumour, Resection margin, Prognostic factors, Surgical treatment

Core Tip: Tumour rupture is a remarkable risk factor that can change the natural history of low-risk gastrointestinal stromal tumours (GISTs) to a high-risk GIST. This review analyses the concept and prognostic value of tumour rupture in GISTs and highlights the impact of the risk of tumour rupture on the choice of surgical strategy.