GIST of stomach: an update on surgery

Gastrointestinal stromal tumors (GISTs) are rare tumors and represent approximately 0.1-3% of all gastrointestinal cancers. They can occur anywhere in the gastrointestinal tract, but the stomach is the most affected area (60-70%). Traditionally, gastric GIST resection has been carried out by means of open surgery, but more recently, less invasive methods have been described. The fact that routine lymphadenectomy are not associated with an improved oncologic outcome (as adult GIST do not metastasize to lymph nodes) advocates in favor of laparoscopic treatment of GISTs. The laparoscopic approach mimics the open approach and allows full-thickness resection of the stomach wall containing the tumor with negative margins. Compared to open resection, laparoscopic resection of gastric GIST is associated with a shorter operation time, a shorter hospital stay, and a lower recurrence rate. For the treatment of gastric GISTs located at less reachable sites laparoscopic resection cannot be applied easily and single incision laparoscopic surgery (SILS) can offer an advantage in these cases. It allows direct visualization of the lesion and better control of the surgical margin. This new technique may also provide evolution towards the use of SILS device for other intragastric procedures. Since the discovery of highly active targeted therapies, resulting in a drastic improvement of the long-term outcome of GIST, this disease has a better prognosis than before 2000.