[Surgical management of gastrointestinal stromal tumors]

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumor of the gastrointestinal tract. GISTs have characteristic by a specific histological and immunohistochemical pattern. Malignant biological behaviors should be paid more attention in treatment. At present, operation is still the most important treatment method for GISTs. For patients with primary, localized GISTs, surgery represents the only chance of cure. The principle of surgery is complete resection of visible and microscopic lesions. Special care needs to be taken to avoid capsule rupture and intra-abdominal spillage, which increase the risk of recurrence. Positive resection margins may result in a higher risk of local and peritoneal relapse. Every effort should be taken to achieve negative margins. Although wide margins have not been shown to be beneficial, an en bloc resection is still recommended, when GISTs are densely adherent to adjacent organs. As GISTs rarely metastasize to lymph nodes, lymphadenectomy is not routinely indicated. While laparoscopic resection of GISTs is technically possible, it should only be undertaken when it will not increase the chance of tumor rupture. The success of imatinib in the treatment of recurrent and metastatic GISTs have prompted investigation into the adjuvant treatment for the significant risk of recurrence of GISTs and neo-adjuvant treatment for unresectable cases. Combined complete surgical resection and molecular therapy are the new therapy model which will improve therapeutic effect.