Gut stromal tumors and their clinical behavior

Background Gut stromal tumors (GST) are a group of intramural intestinal tumors formerly known as leiomyoma and leiomyosarcoma. To improve the understanding of GST behavior, we posed the following questions: What are the clinical sequelae? Do size and symptoms correlate? What are the indications for excision? Methods A retrospective analysis (1988 to 1996) of the clinical course for GST patients was completed including long-term follow-up. Results We found 39 patients with GST during the last 8 years. Their average age was 65 years and 59% were male. Tumors were found in the small bowel or stomach in 95% of cases. All patients were treated by surgical excision. Histologic grading yielded a benign diagnosis in 77%. Tumors were found incidentally at laparotomy in 41% and had an average size of 1.5 cm. In contrast, 59% of GST patients were symptomatic and the average size was 6 cm. In these 23 symptomatic patients, gastrointestinal bleeding occurred in 70%, of which acute hemorrhage was seen in 69–82% of them required transfusion and half required emergent operation. Additional findings in the symptomatic group included abdominal pain (57%), bowel obstruction (30%), and perforation (9%). An average long-term follow-up of 2.5 years was obtained in all patients (n = 34, 5 had died of other causes). Local recurrence was seen in 2 patients, metastatic disease in 2 other patients, and 30 (88%) were disease free. No patient with a GST discovered incidentally has had it recur. Conclusion Gut stromal tumors are uncommon yet cause significant patient morbidity. Small GST (2 cm) were asymptomatic but larger GST were usually symptomatic. Most GST behaved in a benign fashion after local resection. Due to the frequency of serious complications in symptomatic patients, complete excision is recommended for GST, even if incidentally discovered.