Surgical Treatment of Liver Metastases from Gastrointestinal Stromal Tumor

Abstract

Introduction: Gastrointestinal stromal tumors (GISTs) are rare tumors which can arise within in most parts of gastrointestinal tract. Most common sites of metastatic spread are liver and the peritoneum. Thyrosinkinase inhibitors greatly improved prognosis of the locally advanced and metastatic disease allowing patients to gain several years of overall survival, yet majority of them will eventually develop progression and succumb to disease. The role of surgical therapy in metastatic setting still remains unclear. Methods: Within the years 2011 - 2020, we performed 29 surgical procedures on 24 patients with liver metastasis from GISTs. We monitored postoperative morbidity, DFI and overall survival in all patients. Results: We identified 24 patients (range 32-80 years), 17 men and 7 women. In 15 patients a metachronous occurrence of metastases was found, most often within the median 2 years after the primary resection (range 2 - 9 years). 9 patients had synchronous disease. 6 synchronous resections were performed (primary tumor and liver), 3 stage resection were performed. 6 large resections were performed, otherwise mainly extraanatomical resections, eventualy combined with RFA (4x) were performed. Only RFA was performed 5 times. The morbidity according to Clavien – Dindo cassification > 2 was 24 %. 20 patients (83%) received systemic treatment before the surgery, and 21 patients (88%) after the surgery. The 1-, 3- and 5-year survival rate was 91%, 86%, and 72%. Conclusion: Surgical treatment of liver metastases from GIST is a safe method. RO resection and a good therapeutic response to systemic thyrosinkinase inhibitors therapy is an important predictive factor of reccurrence. A multidisciplinary approach for treatment of liver metastases from GISTs is necessary. We need further studies to determine the benefits of surgical treatment.