Onkologie. 2010:4(1):9-12

Surgical treatment of gastrointestinal stromal tumours

Martin Oliverius¹, Martin Varga¹, Eva Honsová²

¹ Klinika transplantační chirurgie IKEM, Praha

² Pracoviště klinické a transplantační patologie IKEM, Praha

Gastrointestinal stromal tumours (GISTs) are the most common gastrointestinal mesenchymal tumours with an incidence of about 7–19 cases

per one million population. They occur in the whole gastrointestinal tract; the predilection sites include the stomach (65 %), small intestine

(25 %), large intestine and rectum (5–10 %) and rarely the oesophagus and other sites (5 %). The incidence in the Czech Republic is not exactly

known but it is estimated to be 300–350 new cases per year. The treatment is primarily surgical. Unlike malignant epithelial GIT tumours

that are very likely to metastasize and require, in addition to being removed radically, a very radical sentinel lymphadenectomy, the surgical

treatment for GIST is mostly restricted to radical resection of the tumour from healthy tissue. Extensive foci sometimes require multiorgan

resection but success is mainly determined by their removal without disrupting integrity. The methods of surgical treatment depend on

the experience of the workplace and include both the classic open approach technique as well as the more increasingly used mini-invasive

laparoscopic procedures. The disease prognosis depends on the radicality of surgery and the malignant potential which is determined by

the size of the tumour and mitotic index. Adjuvant treatment for GIST is provided by a specialized oncological centre and, in most cases,

consists in administering molecular-targeted biological therapy. The introduction of targeted biological therapy using imatinib mesylate

represents a tremendous progress with a dramatic improvement in survival outcomes for both advanced and metastatic forms of the disease.

Currently, other tyrosine kinase inhibitors, such as sunitinib malate, sorafenib, nilotinib or masitinib, are available. Although there are strong

suggestions that neoadjuvant therapy might be beneficial in treating advanced stages of GIST, no evidence-based data are available to date

that would warrant its use. At present, phase II trials are under way in Germany and Canada that will resolve these issues.

Keywords: gastrointestinal stromal tumours, surgical treatment, chemotherapy, imatinib, tyrosine kinase inhibitors, biological therapy, gastrointestinal mesenchymal tumour

Published: March 1, 2010  Show citation