Current scenario and future perspectives of minimally invasive approaches in rectal gastrointestinal stromal tumours

Gastrointestinal stromal tumours (GISTs) of the rectum are rare, corresponding to 0.1% of all rectal lesions. Their clinical course is generally more aggressive and with a higher risk of malignancy than GIST of other gastrointestinal sites. The only curative option for rectal GIST is surgery, which can be upfront or be combined with neoadjuvant chemotherapy with the tyrosine-kinase inhibitor Imatinib for tumor downstaging. Indeed, more than 85% of cases present mutations that make them susceptible to treatment with imatinib. The aim of surgery is to achieve a R0 resection, either by local excision or extended resection, while lymphadenectomy is not required. Surgical treatment of rectal GIST can be carried out via minimally invasive approaches, with an increasing number of reports of laparoscopic and robotic transabdominal extended resections, and of transanal endoluminal local excision, either with transanal endoscopic surgical platforms or robotic platforms. Surgeon expertise in minimally invasive techniques is crucial to ensure adequate oncological outcomes. The role of minimally invasive surgery for treatment of rectal GIST is likely to become more prominent in our near future, as those techniques get more widespread and technological advances provide better ergonomics, better visualization and cheaper appliances.