[Rethinking several issues related to surgical treatment for advanced GIST in the era of targeted therapy]

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the gastrointestinal tract, and tyrosine kinase inhibitors (TKIs) have achieved great success in the treatment of GISTs. The role and value of surgery in advanced GISTs are still controversial. This article aims to review the progress related to surgery for advanced GIST in the context of targeted therapy, particularly exploring the issues related to the combination of surgery and targeted therapy. Studies have shown that selected advanced GISTs can benefit from surgery, but there is still a lack of universally accepted screening criteria and operational norms, and multiple factors affect the effectiveness of surgical treatment for advanced GISTs. Different surgical strategies should be developed for imatinib-resistant GISTs or multiple TKI-resistant GISTs. During the period when the tumors respond to imatinib, cytoreductive surgery is most likely to improve the survival of patients. Early or localized progression should be identified and promptly intervened with surgery. At present, there are few studies on sunitinib or regorafenib combined with surgery, and their feasibility and value are still controversial. Ripretinib combined with cytoreductive surgery may be a new breakthrough point.