title: Repeated surgery improves survival in recurrent gastrointestinal stromal tumors: a retrospective analysis of 144 patients.
abstract: OBJECTIVE
  Recurrence of a gastrointestinal stromal tumor (GIST) may require multimodal therapy and the role of repeated surgery in this concept is unclear.
  
  
  METHODS
  A consecutive series of GIST patients treated by surgery, imatinib therapy or both was retrospectively reviewed, and long-term survival was studied by Kaplan-Meier analysis.
  
  
  RESULTS
  Institutional primary surgeries before 1999 necessitated reclassification of the histopathological sections and 58/78 patients were classified as having true GIST. In primary surgeries, liver metastases were observed in GIST (6/58) but not in sarcoma/schwannoma patients (0/20), and exulceration of the primary tumor did not correlate with adverse outcome. Additionally, 86 patients were seen on an outpatient basis or were treated for recurrence at our institution, thus a total of 144 GIST patients were seen at our institution between 1994 and 2007 for either primary or secondary tumor manifestation. After 2003, 19/144 GISTs recurred and were treated by targeted therapy with imatinib. The patients showed better overall survival than historic controls. Imatinib therapy enhanced re-resectability due to tumor downsizing, and re-resection (n = 16) improved survival significantly (p = 0.046, log-rank test).
  
  
  CONCLUSIONS
  A multimodal approach including targeted therapy and repeated surgery in the long-term management of recurrent GIST improves survival.
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Paulus
authors.initials: P
authors.lastname: Schurr
authors.forename: Dietmar
authors.initials: D
authors.lastname: Kohrs
authors.forename: Uta
authors.initials: U
authors.lastname: Reichelt
authors.forename: Jussuf
authors.initials: J
authors.lastname: Kaifi
authors.forename: Yogesh
authors.initials: Y
authors.lastname: Vashist
authors.forename: Kai
authors.initials: K
authors.lastname: Bachmann
authors.forename: Dean
authors.initials: D
authors.lastname: Bogoevski
authors.forename: Emre
authors.initials: E
authors.lastname: Yekebas
authors.forename: Jakob
authors.initials: J
authors.lastname: Izbicki
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D001549:Benzamides; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D000068877:Imatinib Mesylate; D053208:Kaplan-Meier Estimate; D007889:Leiomyoma / Q000473:pathology / Q000601:surgery*; D007890:Leiomyosarcoma / Q000473:pathology / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009442:Neurilemmoma / Q000473:pathology / Q000601:surgery*; D010879:Piperazines / Q000627:therapeutic use; D011743:Pyrimidines / Q000627:therapeutic use; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate