Gastrointestinal stromal tumor surgery
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]
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Gastrointestinal stromal tumor Microchapters |
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Differentiating Gastrointestinal stromal tumor from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Gastrointestinal stromal tumor surgery On the Web |
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American Roentgen Ray Society Images of Gastrointestinal stromal tumor surgery |
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Directions to Hospitals Treating Gastrointestinal stromal tumor |
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Risk calculators and risk factors for Gastrointestinal stromal tumor surgery |
Surgical Therapy
Surgery is typically the initial therapy for the following types of patients:
Those with primary GIST who do not have evidence of metastasis. Those with tumors that are technically resectable if the risks of morbidity are acceptable.
In the surgical treatment of GIST, the goal is complete gross resection with an intact pseudocapsule and negative microscopic margins.[4] Because lymph node metastasis is rare with GIST, lymphadenectomy of clinically uninvolved nodes is not necessary.
Although a prospective, randomized trial studying the role of laparoscopic surgery in the management of GIST has not been performed, several studies, listed below, indicate a role for this surgical approach with gastric tumors:
- 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.
- Patients who become refractory on imatinib may respond to the multiple tyrosine kinase inhibitor sunitinib (marketed as Sutent).
References