Transanal Endoscopic Microsurgery Following Treatment with Imatinib : a Case Report of a Patient with a Rectal Gastrointestinal Stromal Tumor

Background : Gastrointestinal stromal tumors (GIST) of the rectum are a challenge for the colorectal surgeon. In case of a locally advanced rectal GIST, an extended or multivisceral resection with significant morbidity and mortality is often necessary. Literature is lacking on the combined modality of transanal endoscopisc microsurgery (TEM) following imatinib for these patients. Methods : We describe a combined approach for a locally advanced GIST of the rectum with preoperative imatinib treatment and subsequent local excision using the TEM procedure. Results : After six months of treatment with imatinib the TEM procedure was successfully performed with a radical resection of the remnant tumor. Twenty-four months after surgery this patient has no evidence of disease. Conclusion : A TEM procedure following treatment with imatinib may safely be performed in selected patients with a locally advanced GIST.