title: Liver surgery in the multidisciplinary management of gastrointestinal stromal tumour.
abstract: BACKGROUND
  After the introduction of tyrosine kinase inhibitors (TKIs), the role of surgical resection in treating liver metastasis from gastrointestinal stromal tumour (GIST) is unclear. In this study, we evaluated the outcome of patients treated with TKIs followed by surgery for metastatic GIST.
  
  
  METHODS
  Eleven patients who underwent liver resection after downsizing TKIs therapy for metastatic GIST from 2006 until 2010 were reviewed.
  
  
  RESULTS
  One and 2-year overall survival (OS) rates were 80.8% and 70.7%. All patients with an initially resectable tumour were still alive without recurrence. Patients operated on clinical response had a better outcome (1-year and 2-year OS rate of 100%) than those operated on disease progression (1-year and 2-year OS rates of 60% and 40%; P = 0.043). No deaths were observed among patients who achieved an R0 resection (R0 versus R1/R2, P = 0.001).
  
  
  CONCLUSIONS
  R0 resection and clinical response to TKI are predictors of survival. Surgical resection should be performed as soon as feasible in responder patients. In poor responders, surgery may not add any survival benefit, except in localized progressive disease. In resectable metastatic liver disease, preoperative TKIs or upfront surgery followed by adjuvant therapy could be considered. Larger studies are needed to determine the optimum approach in patients with metastatic GIST.
authors.affiliation: Department of Surgery, The Royal Marsden, London, UK.
authors.forename: Ferdinando C M
authors.initials: FC
authors.lastname: Cananzi
authors.forename: Ajay
authors.initials: A
authors.lastname: Belgaumkar
authors.forename: Bruno
authors.initials: B
authors.lastname: Lorenzi
authors.forename: Satvinder
authors.initials: S
authors.lastname: Mudan
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001549:Benzamides / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D005770:Gastrointestinal Neoplasms / Q000473:pathology*; D046152:Gastrointestinal Stromal Tumors / Q000188:drug therapy / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D006498:Hepatectomy; D006801:Humans; D000068877:Imatinib Mesylate; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010879:Piperazines / Q000627:therapeutic use; D011743:Pyrimidines / Q000627:therapeutic use; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate
keywords: GIST; imatinib; liver metastases; liver resection; preoperative therapy