Gastrointestinal stromal tumor surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]Parminder Dhingra, M.D. [3]

Gastrointestinal stromal tumor Microchapters
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Differentiating Gastrointestinal stromal tumor from other Diseases
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Overview

The predominant therapy for gastrointestinal stromal tumor is surgical resection. Adjunctive chemotherapy/tyrosine Kinase Inhibitor therapy may be required.

Surgical Therapy

Surgery is the definitive therapy and typically the initial therapy for patients of GIST.

• Surgical resection offers an opportunity to completely cure GIST.
• Laparoscopic resection is the most preferred route of surgery. The indications for surgery include:
  • Symptomatic patients with locally advanced or metastatic disease.
  • Large lesions and tumors that are technically resectable if the risks of morbidity are acceptable

• Surgical resection of GIST include complete gross resection with with an intact pseudocapsule and negative microscopic margins.
• In GIST, lymph node metastasis is rare and therefore lymphadenectomy of clinically uninvolved nodes is not necessary.

• Most small GISTs (<5 and especially <2 cm) with a low rate of mitosis (<5 dividing cells per 50 high-power fields) are benign and, after surgery, do not require adjuvant therapy.

• Larger GISTs (>5 cm), and especially when the cell division rate is high (>6 mitoses/50 HPF), may disseminate and/or recur.

• Until recently, GISTs were notorious for being resistant to chemotherapy, with a success rate of <5%. Recently, the c-kit tyrosine kinase inhibitor imatinib, a drug initially marketed for chronic myelogenous leukemia, was found to be useful in treating GISTs, leading to a 40-70% response rate in metastatic or inoperable cases.