Surgical Treatment of Gastrointestinal Stromal Tumors Located in the Stomach in the Imatinib Era.

Background Imatinib has changed the treatment of gastrointestinal stromal tumours (GISTs). Preoperative imatinib treatment can be administered to patients with locally advanced disease to reduce the risk of incomplete resection, tumour spill and lessen the extent of resection. In metastatic GIST, surgery follows imatinib in responding patients with resectable disease. In this study, the outcome of surgically treated patients with a gastric GIST with and without preoperative imatinib was investigated. Methods Patients surgically treated for a gastric GIST at our institute between 1999 and 2011 were included. Patient data were retrieved from a prospectively maintained database. Results A consecutive series of 47 patients was identified: 17 patients were treated with primary surgery (group 1) and 30 patients received imatinib prior to surgery (group 2). Preoperative imatinib led to a 33% reduction in tumour size. All patients in group 1 and 23 patients (77%) in group 2 had a complete resection (R0) without tumour spill. At a median followup of 30 months, four patients in group 2 had died of GIST. In these 4 patients, either the resection had been irradical or tumour spill had occurred, and 3 of them had radiological progressive disease at the time of surgery. Conclusions In this surgical series of gastric GIST patients, preoperative imatinib led to a major reduction in tumour size. Irradical resection, tumour spill and progressive disease at the time of surgery were associated with poor prognosis.