关键词: 胃肠间质瘤, 围手术期, 死亡, 靶向治疗

Abstract: The clinicopathological data of perioperative death cases of patients with gastrointestinal stromal tumors (GIST) were analyzed to provide a reference for clinical diagnosis and treatment.  Methods    The clinicopathological data of 8 GIST patients who died during the perioperative period after surgery in the Department of Gastrointestinal Surgery of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology were retrospectively analyzed.  Results    Among the 8 patients, 3 patients were treated preoperatively and 4 patients with recurrence and metastasis received targeted drug therapy. One patient did not receive targeted therapy due to an acute abdomen. Among the 7 patients with targeted therapy, 6 patients underwent surgery after reaching the maximum effect of targeted therapy, and 1 patient underwent surgical treatment due to disease progression. The median operation time was 240(160~435) min; the median bleeding volume was 450 (50~4500) mL. Among the 4 patients with postoperative recurrence, 1 patient died 28 days after surgery due to postoperative complications of lung cancer (acute respiratory distress syndrome); one patient suffered hemorrhagic shock after surgery, and bleeding was found to ooze from the wound surface of the left diaphragm during the second surgical exploration and died 1 day after the operation due to intra-abdominal hemorrhage; one patient developed septic shock after the operation, and the infection symptoms were not relieved after removing the compression pad during the second operation, and the patient died due to septic shock 15 days after the operation; one patient was infected with new coronavirus pneumonia after surgery, developed hypoxemia and respiratory distress, and died 8 days after surgery after symptomatic treatment. Among the 3 patients who received preoperative treatment, 1 patient suddenly vomited blood 13 days after surgery and died due to the ineffective treatment of blood transfusion and emergency endoscopic hemostasis; one patient developed abdominal bleeding 7 days after surgery, and hemorrhage were successfully stopped after common hepatic artery embolization by digital subtraction angiography, but disseminated intravascular coagulation occurred after being transferred to the ICU and died 8 days after the operation; one patient died 2 days after surgery due to excessive intraoperative blood loss which was ineffective after treatment with drugs to stop bleeding and blood transfusions. One patient’s intratumoral necrosis and infection focus entered the bloodstream during the operation, causing sepsis and septic shock, anti-infection and anti-shock treatment  were ineffective, and the patient died 1 day after surgery.  Conclusion    For GIST patients who undergo preoperative targeted therapy or multiple lines of targeted therapy for recurrence and metastasis, and then undergo surgery with high surgical risks, clinicians should actively conduct multidisciplinary discussions before surgery, strictly control surgical indications, and fully stop the use of targeted drugs, correct adverse reactions, improve preoperative conditions, perform precise intraoperative procedures to reduce the risk of wound bleeding and tumor rupture, and strengthening postoperative management, it is expected to reduce the risk of perioperative death in GIST patients.

Key words: gastrointestinal stromal tumors, perioperative, death, targeted therapy