Surgical treatment of gastrointestinal stromal tumors

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, though they represent a small proportion of overall gastrointestinal malignancies. Originating from the interstitial cells of Cajal, GISTs exhibit a broad spectrum of clinical behavior, ranging from indolent lesions to aggressive malignancies that can arise throughout the gastrointestinal tract, most frequently in the stomach and small intestine, and rarely in extra-gastrointestinal sites such as the omentum, mesentery, or retroperitoneum. Surgical management, particularly for gastric GISTs, increasingly favors minimally invasive approaches, including laparoscopic, robotic, and endoscopic techniques, while preserving oncologic safety. Complete surgical excision with negative margins remains the cornerstone of curative therapy for primary gastric GISTs. Indications for surgery are most often related to symptomatic gastric GISTs at initial presentation. Optimal patient care relies on a multidisciplinary strategy integrating surgical management, pathology, imaging, risk stratification, and targeted medical therapies, ensuring individualized treatment plans and improved outcomes.