title: Salvage surgery for patients with recurrent gastrointestinal sarcoma: prognostic factors to guide patient selection.
abstract: BACKGROUND
  Gastrointestinal sarcomas are rare stromal tumors and most are classifiable as malignant gastrointestinal stromal tumors. They have a high propensity for intraabdominal recurrence. It is unclear whether there is a survival advantage from reoperation for recurrent disease or if surgery should be confined to symptom relief. The authors have attempted to identify features that may allow the selection of patients most likely to benefit from reoperation.
  
  
  METHODS
  Retrospective univariate and multivariate analyses of 60 patients with recurrent gastrointestinal sarcoma, accrued from a prospective data base between July 1982 and September 1995, were performed.
  
  
  RESULTS
  Initial recurrence was evident by a median of 20 months from primary resection. Most patients (85%) had an initial symptomatic recurrence. Local recurrence was seen in 76% of patients, but in half of these synchronous hepatic metastases were present. None had disease outside of the abdomen. Complete resection of recurrent disease was possible in only one-third of cases. Median survival after surgery for recurrence was 15 months, but was longest for patients whose recurrence took the form of liver metastases in the absence of disease elsewhere. In multivariate analysis of post-recurrence survival, the only significant determinant of survival was the length of the disease free interval between the initial operation and recurrence.
  
  
  CONCLUSIONS
  Survival following recurrence of a gastrointestinal sarcoma is largely determined by the tumor biology, one manifestation of which is the disease free interval. Except for patients with a long disease free interval, surgery should be reserved largely for symptom control.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Mudan
authors.forename: K C
authors.initials: KC
authors.lastname: Conlon
authors.forename: J M
authors.initials: JM
authors.lastname: Woodruff
authors.forename: J J
authors.initials: JJ
authors.lastname: Lewis
authors.forename: M F
authors.initials: MF
authors.lastname: Brennan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D018572:Disease-Free Survival; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D018579:Patient Selection; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D016879:Salvage Therapy; D012509:Sarcoma / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome