View source for Gastrointestinal stromal tumor surgery

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{{CMG}};{{AE}}{{Akshun}}{{PSD}}
{{Gastrointestinal stromal tumor}}
==Overview==
The predominant therapy for gastrointestinal stromal tumor (GIST) is surgical resection. Surgical resection offers an opportunity to completely cure GIST. [[Laparoscopic]] and [[endoscopic]] resection are the most preferred route of surgery. Surgical [[resection]] of GIST include complete gross resection with an intact pseudocapsule and negative [[microscopic]] margins.
==Surgical Therapy==

[[Surgery]] is the definitive therapy and typically the initial therapy for patients of  gastrointestinal stromal tumor (GIST).
*Surgical resection offers an opportunity to completely cure GIST.
*[[Laparoscopic]] and [[endoscopic]] resection are the most preferred route of surgery. The indications for surgery include:<ref name="pmid23917593">{{cite journal |vauthors=Liang JW, Zheng ZC, Zhang JJ, Zhang T, Zhao Y, Yang W, Liu YQ |title=Laparoscopic versus open gastric resections for gastric gastrointestinal stromal tumors: a meta-analysis |journal=Surg Laparosc Endosc Percutan Tech |volume=23 |issue=4 |pages=378–87 |year=2013 |pmid=23917593 |doi=10.1097/SLE.0b013e31828e3e9d |url=}}</ref><ref name="pmid23898104">{{cite journal |vauthors=DE Vogelaere K, VAN DE Winkel N, Simoens C, Delvaux G |title=Intragastric SILS for GIST, a new challenge in oncologic surgery: first experiences |journal=Anticancer Res. |volume=33 |issue=8 |pages=3359–63 |year=2013 |pmid=23898104 |doi= |url=}}</ref><ref name="pmid23233005">{{cite journal |vauthors=De Vogelaere K, Hoorens A, Haentjens P, Delvaux G |title=Laparoscopic versus open resection of gastrointestinal stromal tumors of the stomach |journal=Surg Endosc |volume=27 |issue=5 |pages=1546–54 |year=2013 |pmid=23233005 |doi=10.1007/s00464-012-2622-8 |url=}}</ref><ref name="pmid28486486">{{cite journal |vauthors=Ye L, Wu X, Wu T, Wu Q, Liu Z, Liu C, Li S, Chen T |title=Meta-analysis of laparoscopic vs. open resection of gastric gastrointestinal stromal tumors |journal=PLoS ONE |volume=12 |issue=5 |pages=e0177193 |year=2017 |pmid=28486486 |pmc=5423634 |doi=10.1371/journal.pone.0177193 |url=}}</ref>
**Symptomatic patients with locally advanced 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 an intact pseudocapsule and negative [[microscopic]] margins. 
* The GIST are highly [[vascular]] [[tumors]] and have a very fragile pseudocapsule and therefore the surgeon must be really careful regarding the risk of [[tumor]] rupture and subsequent [[peritoneal]] dissemination. 
* In GIST,  [[lymph node]] [[metastasis]] is rare and therefore [[lymphadenectomy]] and extensive [[lymph node]] exploration is rarely required. 

* 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]] with [[tyrosine kinase inhibitors]].

* Larger GISTs (>5 cm), and especially when the cell division rate is high (>6 [[mitosis|mitoses]]/50 HPF), may disseminate and/or recur and may be treated with [[tyrosine kinase inhibitors]].

* Previously GIST were resistant to conventional [[chemotherapy]] and had a mere success rate of <5%.
* With the advent of ''c-kit'' [[tyrosine kinase]] inhibitor such as [[imatinib]], the response rate has gone up from 5% to 40-70% in metastatic or inoperable cases.<ref>{{Cite web | title =Gastrointestinal Stromal Tumors Treatment
| url =http://www.cancer.gov/types/soft-tissue-sarcoma/hp/gist-treatment-pdq#section/_35}}</ref>

==References==
{{reflist|2}}

[[Category:Disease]]
[[Category:Gastroenterology]]
[[Category:Types of cancer]]


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