Indications for surgery in advanced/metastatic GIST

Area of Science:

• Gastrointestinal Oncology
• Surgical Oncology
• Medical Oncology

Background:

• Gastrointestinal stromal tumors (GISTs) are rare, often presenting as locally advanced or metastatic disease.
• Complete surgical resection is curative for localized GIST.
• Imatinib therapy has revolutionized GIST management, serving as an adjunct to surgery and primary treatment for metastatic disease.

Purpose of the Study:

• To review the evolving role of surgery in advanced GIST management.
• To explore the combined treatment approach of surgery with imatinib therapy.
• To evaluate the impact of neoadjuvant imatinib and surgical interventions in advanced GIST.

Main Methods:

• Review of current literature on GIST management, focusing on surgical and imatinib-based treatment strategies.
• Analysis of the benefits of neoadjuvant imatinib in rendering locally advanced GIST resectable.
• Discussion of the controversial role of surgery in metastatic or recurrent GIST.

Main Results:

• Neoadjuvant imatinib can improve resectability, enable less invasive procedures, and preserve organ function in locally advanced GIST.
• Surgery in metastatic or recurrent GIST is case-selective, potentially offering limited benefits in progression-free and overall survival for select patients responding to imatinib.
• Surgery is generally not recommended for imatinib-resistant GIST unless for emergency palliative intervention.

Conclusions:

• The combined approach of imatinib and surgery represents a significant advancement in managing advanced GIST.
• Careful patient selection is crucial for optimizing surgical outcomes in metastatic or recurrent GIST.
• Imatinib therapy remains central to GIST management, with surgery playing a complementary role in specific clinical scenarios.