title: Role of upfront surgery for recurrent gastrointestinal stromal tumours.
abstract: BACKGROUND
  Gastrointestinal stromal tumours (GISTs), despite complete surgical cytoreduction, are associated with recurrence rates of up to 50% at 2 years. At recurrence, tyrosine kinase inhibitor (TKI) therapy is recommended, conferring a survival of up to 55 months. Several studies have shown that patients with TKI-responsive recurrent GIST benefit from surgery. However, no studies have compared upfront surgery versus TKI alone.
  
  
  METHODS
  Data were retrospectively collected from patients with recurrent GIST treated at Singapore General Hospital and National Cancer Centre Singapore over a 12-year period. Our primary end points were disease-free and overall survival (OS).
  
  
  RESULTS
  A total of 186 patients underwent curative surgery for GIST between January 2000 and June 2012. Fifty-six (30%) patients experienced recurrence, of which 30 (54%) had resectable recurrent disease. Twenty-four patients underwent upfront surgery for their recurrence while the remaining six patients opted for non-surgical management. The median OS for all patients with recurrent GIST was 5.3 years (95% confidence interval (CI) 3.2-8.4). It was not reached for patients who underwent curative surgery for their recurrence, and was 3.9 years (95% CI 2.4-7.0) for patients who had palliative TKI and conservative management. There were significant differences in OS and disease-specific survival between patients who underwent curative surgery for recurrence compared with those who had not.
  
  
  CONCLUSIONS
  Our study shows that upfront surgery is a reasonable treatment strategy for selected patients with recurrent GIST.
authors.affiliation: Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.
authors.forename: Grace Hwei Ching
authors.initials: GH
authors.lastname: Tan
authors.affiliation: Department of General Surgery, Singapore General Hospital, Singapore.
authors.forename: Jolene Si Min
authors.initials: JS
authors.lastname: Wong
authors.affiliation: Department of Medical Oncology, National Cancer Centre Singapore, Singapore.
authors.forename: Richard
authors.initials: R
authors.lastname: Quek
authors.affiliation: Department of General Surgery, Singapore General Hospital, Singapore.
authors.forename: Brian Kim Poh
authors.initials: BK
authors.lastname: Goh
authors.affiliation: Department of Biostatistics, National Cancer Centre Singapore, Singapore.
authors.forename: Li Lian
authors.initials: LL
authors.lastname: Kwok
authors.affiliation: Department of Biostatistics, National Cancer Centre Singapore, Singapore.
authors.forename: Summer
authors.initials: S
authors.lastname: Pan
authors.affiliation: Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.
authors.forename: Khee Chee
authors.initials: KC
authors.lastname: Soo
authors.affiliation: Department of Surgical Oncology, National Cancer Centre Singapore, Singapore. melissa.teo.c.c@nccs.com.sg.
authors.forename: Melissa Ching Ching
authors.initials: MC
authors.lastname: Teo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005544:Forecasting; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D046152:Gastrointestinal Stromal Tumors / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012846:Singapore / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: GIST; recurrence; surgery