Diagnosis and surgical treatment of primary gastrointestinal tumors in children

Objective To explore the clinical features and the diagnosis and surgical treatment of primary gastrointestinal tumors in children. Methods The clinical data including tumor sites, pathological types, clinical manifestation, imaging findings, effective treatment and prognosis were retrospectively analyzed for 17 consecutive surgical patients at our department between January 2009 and April 2014. There were 11 males and 6 females with a mean age of 5.5 (0.25-14) years. The major clinical manifestations were abdominal mass, abdominal pain, vomiting, fever, emaciation and alimentary tract hemorrhage. In 14 patients, computed tomography (CT), ultrasound and gastrointestinal endoscopy showed space-occupying lesions in gastrointestinal tract. And abdominal radiology demonstrated intestinal obstruction in another 3 cases. Primary gastric tumor was found in 3 cases, including blue rubber bleb nevus syndrome (n=2) and malignant teratoma (n=1). And intestinal tumor was found in 14 cases, including intestinal lymphangioma (n=3), malignant lymphoma (n=4), signet ring cell carcinoma (n=2), original neural ectoderm tumor (n=3) and hemangioma (n=2). Results Among them, 14 cases underwent (gastric) intestinal resection and anastomosis and the remainder received an injection of Streptococcus A Group. And biopsy was performed in 3 cases. For 10 cases with malignant tumor, 1 case died at Day 6 post-operation, 1 case was discharged with discontinued treatment at Day 2 post-operation and another case declined postoperative chemotherapy. Except for 3 cases lost to follow-ups, the other 7 ones underwent postoperative chemotherapy. Both 7 cases with benign tumors and another 7 with malignant tumors on adjuvant postoperative chemotherapy were followed up for 6 months to 5 years. All survived without tumor recurrence or metastasis. Conclusions Due to unspecific presentations, the diagnosis is difficult for children with primary tumor. It is often complicated with acute abdominal. Computed tomography, ultrasound and gastrointestinal endoscopy may aid the diagnosis. The tumor should be removed completely as far as possible. Primary benign tumor has a fair prognosis. Surgical resection or combinational chemotherapy are indicated for treating malignant tumors. At the same time, further long-term follow-ups should be conducted for elucidating the mechanisms of tumor recurrence and metastasis. Key words: Gastrointestinal neoplasms; Surgical procedures, operative; Treatment outcome