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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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:
  • 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 mitoses/50 HPF), may disseminate with surgery and/or recur and additionally 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.