Advances of endoscopic and surgical management in gastrointestinal stromal tumors

Abstract

As one of the most common mesenchymal malignancies in the digestive system, gastrointestinal stromal tumors (GISTs) occur throughout the alimentary tract with diversified oncological characteristics. With the advent of the tyrosine kinase inhibitor era, the treatment regimens of patients with GISTs have been revolutionized and GISTs have become the paradigm of multidisciplinary therapy. However, surgery resection remains recognized as the potentially curative management for the radical resection and provided with favorable oncological outcomes. The existing available surgery algorithms in clinical practice primarily incorporate open procedure, and endoscopic and laparoscopic surgery together with combined operation techniques. The performance of various surgery methods often refers to the consideration of risk evaluation of recurrence and metastases; the degree of disease progression; size, location, and growth pattern of tumor; general conditions of selected patients; and indications and safety profile of various techniques. In the present review, we summarize the fundamental principle of surgery of GISTs based on risk assessment as well as tumor size, location, and degree of progress with an emphasis on the indications, strengths, and limitations of current surgery techniques.

Duodenal gastrointestinal stromal tumor presenting with life‐threatening upper GI bleeding in a young patient: A case report and literature review

“…Radical surgical resection is the standard treatment for localized primary GISTs, which is the potentially curative 31 . Indications for surgery include nongastric location, tumor size larger than or equal to 2 cm, or symptoms like gastrointestinal bleeding 32 . Lymphadenectomy is usually not required, since GISTs rarely metastasize to local or regional lymph nodes 6,15 …”

“…31 Indications for surgery include nongastric location, tumor size larger than or equal to 2 cm, or symptoms like gastrointestinal bleeding. 32 Lymphadenectomy is usually not required, since GISTs rarely metastasize to local or regional lymph nodes. 6,15 The available operative approaches to manage duodenal GIST consist of open surgery, endoscopy, laparoscopy, and hybrid surgery such as endo-laparoscopic cooperative procedure.…”

“… 31 Indications for surgery include nongastric location, tumor size larger than or equal to 2 cm, or symptoms like gastrointestinal bleeding. 32 Lymphadenectomy is usually not required, since GISTs rarely metastasize to local or regional lymph nodes. 6 , 15 …”

Gastro-intestinal stromal tumors (GIST)

“…Patients devoid of mutations do not respond to imatinib. For imatinib refractory GISTs, sunitinib (Tyrosine kinase inhibitor) is useful as the drug targets multiple kinases such as VEGF, EDGFR, PDGFRA, KIT and FLT3 [9] . If facilities for PET scan are available then pre-operative screening for GIST as well as detecting early response to imatinib can be done.…”

“…High risk patients may require follow up with CT/MRI every 3-6 months for the first 5 years during adjuvant therapy. After completion of adjuvant therapy, follow up every 3 months for the first 2 years and subsequently every 6 months for next 5 years and thereafter annually for additional 5 years is advisable [8,9,10] .…”