title: Multivisceral resections for gastrointestinal stromal tumors: are the risks justifiable?
abstract: BACKGROUND
  Surgical resection is the cornerstone of treatment for non-metastatic gastrointestinal stromal tumors (GISTs). Multivisceral resection (MVR) for locally advanced tumors is often required to achieve negative margins. The purpose of this study was to review the peri-operative and long-term oncologic outcomes for patients who required MVR versus single-organ resection (SOR) for GISTs.
  
  
  METHODS
  All patients who underwent treatment for GISTs at a tertiary cancer center between 2001 and 2011 were identified. Patient characteristics and clinical outcomes were compared using the chi-squared/Fisher's exact test and Student's t-test. Disease-free (DFS) and overall survival (OS) were analyzed using the Kaplan-Meier product-limit method.
  
  
  RESULTS
  33 patients underwent MVR and 77 underwent SOR. Tumors in the MVR group were larger and had a higher mitotic index. MVR patients had longer operative times, greater operative blood loss and more peri-operative complications. There was no significant difference in the final margin status between the two groups (R0 resection: SOR 92.2%, MVR 81.8%, p = 0.1303). 5-year DFS was significantly lower in the MVR cohort (44.4% vs. 78.9%, p = 0.0090), but there was no difference in 5-year OS (80.2% vs. 90.5%, p = 0.2547).
  
  
  CONCLUSIONS
  MVR patients had more aggressive tumors and more complications; however, there was no difference in 5-year OS between the MVR and SOR cohorts. These findings support the use of MVR in the appropriately selected patient. Further studies are necessary to fully define its clinical application.
authors.affiliation: Department of Surgical Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario M5G 2M9, Canada.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Racz
authors.affiliation: Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario M5T 2S8, Canada.
authors.forename: Supreet
authors.initials: S
authors.lastname: Sunil
authors.affiliation: Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario M5T 2S8, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Abramowitz
authors.affiliation: Department of Surgical Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario M5G 2M9, Canada.
authors.forename: Savtaj S
authors.initials: SS
authors.lastname: Brar
authors.affiliation: Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario M5T 2S8, Canada.
authors.forename: M Carolina
authors.initials: MC
authors.lastname: Jimenez
authors.affiliation: Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario M5T 2S8, Canada.
authors.forename: Arash
authors.initials: A
authors.lastname: Azin
authors.affiliation: Department of Biostatistics, Princess Margaret Cancer Center, University Health Network, Toronto, Ontario M5G 2M9, Canada.
authors.forename: Eshetu G
authors.initials: EG
authors.lastname: Atenafu
authors.affiliation: Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario M5T 2S8, Canada.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Jackson
authors.affiliation: Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario M5T 2S8, Canada.
authors.forename: Allan
authors.initials: A
authors.lastname: Okrainec
authors.affiliation: Department of Surgical Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario M5G 2M9, Canada; Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario M5T 2S8, Canada. Electronic address: Fayez.Quereshy@uhn.ca.
authors.forename: Fayez A
authors.initials: FA
authors.lastname: Quereshy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D002173:Cancer Care Facilities; D013505:Digestive System Surgical Procedures; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D046152:Gastrointestinal Stromal Tumors / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology; D009864:Ontario / Q000453:epidemiology; D062606:Tertiary Care Centers; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: Gastrointestinal stromal tumors; Multivisceral resection; Perioperative outcomes; Survival