Surgical options for localized and advanced gastrointestinal stromal tumors

Abstract

The development of imitinab has led to a revolution in the management of gastrointestinal stromal tumors (GIST), but surgical resection remains the cornerstone of treatment for patients with localized disease. The principles to surgical treatment of GIST include careful handling of tissues to prevent tumor rupture and resection to negative margins without the need for wide excision. Minimally invasive techniques have proven equally efficacious provided appropriate oncologic resections are performed.

Gastrointestinal Bleeding Is an Independent Risk Factor for Poor Prognosis in GIST Patients

“…However, even if the tumor is completely resected, the likelihood of recurrence or metastasis after surgery is about 40%–50% [17]. Before 2001, surgery was the only treatment for GIST with a five-year survival rate of around 50% [18].…”

“…However, it is worth pointing out that a GIST tumor is still likely to recur during the first 5 years after surgery, especially for patients in a high-risk group [20, 21]. Therefore, we should pay more attention to follow-up during this postsurgical period [4, 17, 22]. Although there are some related studies [23], there are no risk stratification criteria that consider gastrointestinal bleeding caused by GIST as a significant indicator.…”

Gastrointestinal Stromal Tumors: Case Series of 29 Patients Defining the Role of Imatinib Prior to Surgery

“…During the era before imatinib (preimatinib era), unresectable and metastatic GISTs had a poor overall prognosis, with a median survival of 12-19 months. Response rates to palliative anthracycline-based chemotherapy ranged from 5 to 10% [4][5][6].…”

Ten‐year review of gastrointestinal stromal tumours at a tertiary referral hospital in New Zealand

“…It remains unclear as to whether patients with low‐volume metastatic GIST tumours should undergo potentially curative surgery. Previous authors have advocated two indications for metastatectomy: either radiological evidence of disease regression after treatment with tyrosine kinase inhibitor therapy or established resistance to such a drug . At present, there is limited evidence that metastatectomy for GIST prolongs OS or DFS, and any benefit may well be secondary to disease responsiveness to tyrosine kinase therapy .…”