Lancet in the era of targeted drug therapy: the role of surgery in the management of advanced gastrointestinal stromal tumor

Abstract

Gastrointestinal stromal tumor(GIST) is the most common mesenchymal tumor in the gastrointestinal tract. Due to the occult onset, GIST may present as local advanced or with metastatic disease at diagnosis. Imatinib mesylate (IM) has effectively improved the prognosis of GIST patients and has been established as principle therapy in metastatic GIST. The role of IM as an adjunction to surgery in the management of high-risk and local advanced GIST is also highly regarded. The role of surgery in metastatic or recurrent GIST is still a controversial clinic problem. For local advanced GIST or GIST in the unfavorable anatomic site(e.g. esophagogastric junction, duodenum, and rectum), based on the limited evidence, surgery may have potential benefits as conversion therapy. Surgery may have a limited favorable impact on progression-free survival and overall survival for those patients whose disease is responding to imatinib or those with limited focal progression. Patients with extensive advanced relapse metastatic GIST or imatinib-resistant disease should not undergo surgery unless emergency situation or complication occurs, where palliative intervention may be justified.