Analysis of the clinical features and surgical treatment of small intestinal stromal tumor: a retrospective study based on 119 cases

BACKGROUND: Small intestinal stromal tumors (SISTs) are mesenchymal neoplasms originating from the interstitial cells of Cajal in the small intestine. As a distinct subtype of gastrointestinal stromal tumors (GISTs), SISTs exhibit greater aggressiveness and poorer prognosis compared to gastric GISTs. Due to their anatomically ambiguous location and nonspecific symptoms, early diagnosis remains challenging. This study conducts a retrospective analysis of clinical data to systematically summarize their clinical characteristics and management experience, aiming to provide insights for addressing diagnostic challenges. METHODS: Clinical data from 119 patients with primary SIST who underwent surgical treatment at the Air Force Medical Center between November 2013 and March 2025 were retrospectively analyzed. RESULTS: The clinical presentation of SIST was often insidious, with intermittent gastrointestinal bleeding (melena or hematochezia) observed as the initial symptom in 84.9% of patients. Anemia was frequently observed during the disease course. Caution is warranted to avoid misdiagnosis as superficial gastritis. The tumors predominantly occurred in the jejunum and ileum. A significant correlation was identified between the risk of recurrence and Ki-67 expression levels. Through a precision medicine approach encompassing "symptom and sign evaluation, radiographic assessment, intraoperative dynamic decision-making, and surgical resection", a stratified surgical strategy was implemented. This approach prioritized both complete tumor eradication and minimal invasiveness. CONCLUSIONS: The diagnosis and management of SIST require vigilance regarding overlapping symptoms and anatomical obscurity, emphasizing the integration of multimodal imaging and a minimally invasive-prioritized surgical strategy.