Surgical Treatment of Gastrointestinal Stromal Tumors Located in the Stomach in the Imatinib Era.
BACKGROUND
Imatinib has changed the treatment of gastrointestinal stromal tumors (GISTs). Preoperative imatinib treatment can be administered to patients with locally advanced disease to reduce the risk of incomplete resection, tumor 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 before surgery (group 2). Preoperative imatinib led to a 33% reduction in tumor size. All patients in group 1 and 23 patients (77%) in group 2 had a complete resection (R0) without tumor spill. At a median follow-up of 30 months, 4 patients in group 2 had died of GIST. In these 4 patients, either the resection had been irradical or tumor spill had occurred, and 3 of them had radiologic progressive disease at the time of surgery.


CONCLUSIONS
In this surgical series of gastric GIST patients, preoperative imatinib led to a major reduction in tumor size. Irradical resection, tumor spill, and progressive disease at the time of surgery were associated with poor prognosis.
Departments of *Surgery †Gastroenterology and Hepatology ‡Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Jurriën
J
Stiekema
Sabrine
S
Kol
Annemieke
A
Cats
Amir T
AT
Yazdi
Frits
F
van Coevorden
Johanna W
JW
van Sandick
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D005260:Female; D005743:Gastrectomy; D046152:Gastrointestinal Stromal Tumors / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D000068877:Imatinib Mesylate / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D000068877:Imatinib Mesylate