title: Role of metastasectomy for recurrent/metastatic gastrointestinal stromal tumors based on an analysis of the Kinki GIST registry.
abstract: OBJECTIVE
  To define the role of surgery for metastatic/recurrent lesions after resection of primary gastrointestinal stromal tumors (GISTs).
  
  
  METHODS
  Based on data obtained from the Kinki GIST registry, patients with recurrence or metastasis were divided into a surgical treatment group (ST group), comprised those treated with surgery in addition to tyrosine kinase inhibitor (TKI) therapy; and a drug treatment group (DT group), comprised those treated with TKI therapy alone. We compared the baseline characteristics and survival outcomes of the groups.
  
  
  RESULTS
  Metastasis or recurrence developed in 93 of the 737 patients with GISTs treated between 2003 and 2007, 50 (53.8 %) of whom were assigned to the ST group and 43 (46.2 %) to the DT group. In the ST group, the 5-year overall survival rate was significantly higher for patients who underwent R0/R1 resection than for those who underwent R2 resection (82.2 vs. 47.0 %, p = 0.018). Survival time after recurrence was correlated with the duration of total TKI therapy in both the ST and DT groups (r = 0.766 and r = 0.932, respectively, p < 0.001).
  
  
  CONCLUSIONS
  Continuous TKI therapy appears to be important primarily for the prognostic improvement of patients with recurrent/metastatic GISTs. R0/R1 resection may have benefits when combined with TKI therapy for patients with stable disease or disease responsive to TKI therapy, less than four metastatic lesions, and lesions <100 mm in total.
authors.affiliation: Department of Surgery, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, 420-8527, Japan. shinsukesato@gmail.com.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Sato
authors.affiliation: Department of Surgery, Kaizuka City Hospital, Osaka, Japan.
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Tsujinaka
authors.affiliation: Department of Surgery, Osaka Police Hospital, Osaka, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Masuzawa
authors.affiliation: Department of Surgery, Osaka National Hospital, Osaka, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Yamamoto
authors.affiliation: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Takahashi
authors.affiliation: Department of Surgery, Osaka City General Hospital, Osaka, Japan.
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Yamashita
authors.affiliation: Department of Surgery, NTT West Osaka Hospital, Osaka, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Fujita
authors.affiliation: Department of Surgery, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, 420-8527, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Takagi
authors.affiliation: Department of Surgical Pathology, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Seiichi
authors.initials: S
authors.lastname: Hirota
authors.affiliation: Department of Gastric Surgery, National Cancer Center Hospital East, Chiba, Japan.
authors.forename: Toshirou
authors.initials: T
authors.lastname: Nishida
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D005770:Gastrointestinal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D046152:Gastrointestinal Stromal Tumors / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D006801:Humans; D000068877:Imatinib Mesylate / Q000008:administration & dosage; D007564:Japan; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D000068877:Imatinib Mesylate
keywords: Gastrointestinal stromal tumors; Surgery; Tyrosine kinase inhibitors