Surgical Treatment

Abstract

Standard treatment of localized, resectable GIST is surgery. In principle, a preoperative diagnosis should always be considered, i.e. through core-needle biopsies, taken by endoscopic ultrasound or percutaneously. Once the diagnosis of GIST has been established, the goal of surgery is complete resection of visible disease, i.e. with negative margins. Tumor rupture should be avoided, because it is associated with an exceedingly high risk of peritoneal seeding and subsequent metastatic extent. Preoperative treatments should be considered when the surgeon perceives that there is a high risk of tumor rupture, along with those cases in which cytoreduction may lead to more conservative procedures. Surgery does not cure metastatic GIST. All the more today, in the era of targeted therapies for GIST, standard treatment of the advanced disease is medical treatment. In the case of limited progression after response to imatinib, surgery may be an option. At the moment It Is uncertain whether surgery of residual metastatic lesions responding to Imatinib may help, although by no means it could allow stopping the medical therapy.