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.
Gastrointestinal Stromal Tumors ; surgery ; Humans

Gastric gastrointestinal stromal tumor(GIST) is the most common mesenchymal neoplasms of the gastro-intestinal tract.For its unique biological behavior with KIT gene expression and the particular clinical characteristics with the recurrent nature, surgery and molecular targeted therapy is the main treatment of gastric GIST. Laparoscopic technology has been used in the surgical treatment of gastric GIST and is the future trend. In this article, we shed some light on the standardize surgical procedures of radical laparoscopic gastrectomy, obeying the surgical principles, accurate intraoperative localization, and surgery combined with targeted therapy.
Gastrectomy ; Gastrointestinal Stromal Tumors ; surgery ; Humans ; Laparoscopy ; Stomach Neoplasms ; surgery

For primary localized gastrointestinal stromal tumor(GIST), complete resection followed by imatinib adjuvant therapy has become a consensus among physicians for median and high risk patients. Preoperative imatinib may decrease surgical morbidity, increase resection rate, and even preserve organ function through down-staging of the tumor. For advanced GIST, the choice of treatment is targeted therapy with tyrosine kinase inhibitor. Although surgical intervention showed certain efficacy in several retrospective analyses, the role of surgery for advanced disease still needs to be proven by prospective controlled trials. Better combination of targeted therapy and surgery has become critical in multidisciplinary therapy for GIST.
Combined Modality Therapy ; Gastrointestinal Stromal Tumors ; drug therapy ; surgery ; Humans

Gastrointestinal Stromal Tumors ; diagnosis ; epidemiology ; surgery ; Humans ; Stomach ; pathology

In recent years, with the development of digestive endoscopy, endoscopic submucosal dissection(ESD) and its derived techniques including endoscopic submucosal excavation(ESE), submucosal tunnelling endoscopic resection(STER) and laparoscopic endoscopic combined surgery(LECS), can cure most of the gastric gastrointestinal stromal tumor(GIST). This article reviews the indication, method and evaluation of endoscopic resection for gastric GIST.
Endoscopy, Gastrointestinal ; methods ; Gastrointestinal Stromal Tumors ; surgery ; Humans ; Stomach Neoplasms ; surgery

Surgery is the only possible cure protocol of gastrointestinal stromal tumor (GIST). But the risk of recurrence exists constantly. Risk assessment of relapse is very important to guide the targeted adjuvant therapy and predict the prognosis. Although the variables and grading in the risk assessment of recurrence after complete resection of primary local GIST have been identified, but either the F/NIH consensus, AFIP standards, modified NIH standards, or risk identification methods attempted to apply mathematical calculation model in recent years, including Jason S Gold risk nomogram, Rossi nomogram, Joensuu high Hotline Dengjun, are short of long-term, large-scale clinical trials without selection bias. Therefore, recurrence risk probability cannot be predicted accurately.
Gastrointestinal Neoplasms ; surgery ; Gastrointestinal Stromal Tumors ; surgery ; Humans ; Neoplasm Recurrence, Local ; Risk Assessment

Some special types of stomach tumors are often encountered in clinical paractice, such as gastrointestinal stromal tumor (GIST), gastric neuroendocrine tumors (NETs), primary gastric lymphoma (PGL) and some special types of gastric cancer. Because of their special pathogenesis and pathological types with lower incidence, the choices of the treatment for these diseases are limited. This article analyzes these special types of stomach tumors in order to improve the understanding of doctors in these diseases.
Gastrointestinal Stromal Tumors ; pathology ; surgery ; Humans ; Lymphoma ; pathology ; surgery ; Neuroendocrine Tumors ; pathology ; surgery ; Stomach Neoplasms ; pathology ; surgery

OBJECTIVETo evaluate the effect of laparoscopic surgery in resection of suspected gastrointestinal stromal tumors.

METHODSA retrospective analysis was conducted among 50 patients with suspected gastrointestinal stromal tumors. All the patients underwent laparoscopic tumor resection. Thirty-eight of the patients had a preoperative diagnosis of gastric submucosa tumor by gastroscopy, and 12 had a diagnosis of small intestinal tumor by small intestinal endoscopy. The surgical procedure, operative time, estimated blood loss, time for passage of flatus, time for eating, postoperative hospital stay, operative complications, pathology and the results of follow-up were analyzed.

RESULTSIn these cases, the mean operative time was 90.84-/+26.69 min, with the mean estimated blood loss of 57.80-/+67.48 ml, mean time for passage of flatus of 50.90-/+18.87 h, mean time for eating of 2.94-/+0.79 days, and postoperative hospital stay of 8.62-/+3.56 days. No patient developed surgical complications, and all the lesions showed negative results on the margins of the resection.

CONCLUSIONAs a minimally invasive surgical approach, laparoscopic resection of suspected gastrointestinal stromal tumors reduces the intraoperative blood loss, promotes postoperative recovery of the patients and achieves R0 resection without causing serious complications.

Gastrointestinal Stromal Tumors ; surgery ; Humans ; Laparoscopy ; methods ; Retrospective Studies ; Stomach Neoplasms ; surgery ; Treatment Outcome

OBJECTIVETo investigate the clinical characteristics and prognosis factors of primary resectable high-risk gastrointestinal stromal tumors (GIST).

METHODSThe clinicopathological and follow-up data of 45 patients with primary resectable high-risk gastrointestinal stromal tumors between January 2002 and November 2010 were retrospectively reviewed.

RESULTSForty-five patients included 18 males and 27 females with a median age of 48 years (range, 28-77 years). Of 45 tumors, 19 (42.2%) located in the stomach, 9 (20.0%) in the small intestine, 7 (15.6%) in the rectum, 4 (8.9%) in the mesentery, and 6 (13.3%) in the retroperitoneum. All the patients received surgical resection and 35 (77.8%) underwent complete resection, 10 (22.2%) underwent resection of ruptured tumors (before or during operation), 33 (73.3%) underwent R0 resection, 5 (11.1%) underwent R1 resection, and 7 (15.6%) underwent R2 resection. All the patients received targeted therapy of imatinib after surgery. The median duration of imatinib was 24 (10-99) months. The main side effect was noticed in all the patients, mainly including edema in 39 (86.7%) patients and leukopenia in 27 (60.0%) patients. The relapse rate was 37.8% (17/45). The 1-, 3-, and 5-year survival rates were 100%, 86.7% and 74.4%, respectively. Univariate and multivariate analysis revealed that the degree of resection was independently associated with the prognosis of high-risk GIST patients.

CONCLUSIONSSurgery is effective treatment for the GIST. Efforts to obtain R0 resection are important to improve the efficacy of primary resectable high-risk GIST.

Adult ; Aged ; Female ; Follow-Up Studies ; Gastrointestinal Neoplasms ; surgery ; Gastrointestinal Stromal Tumors ; surgery ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies

At the end of 2012, Chinese Society of Clinical Oncology (CSCO) amended and revised the expert consensus of gastrointestinal stromal tumor (GIST) 2011. This article is respectively review hot topics regarding surgical intervention during the revision, including principles and indications of biopsy and surgery.
Biopsy ; Consensus Development Conferences as Topic ; Gastrointestinal Neoplasms ; diagnosis ; pathology ; surgery ; Gastrointestinal Stromal Tumors ; diagnosis ; pathology ; surgery ; Humans