title: Is multivisceral resection in locally advanced gastrointestinal stromal tumours an acceptable strategy?
abstract: BACKGROUND
  Gastrointestinal stromal tumours (GISTs) represent the most common mesenchymal tumour of the gastrointestinal tract. Although the efficacy of targeted therapy cannot be over-emphasized, surgery remains the only curative primary treatment for patients with localized disease. The median size of GIST at diagnosis is approximately 5-7 cm; however, it is not uncommon for tumours to be as large as 30-40 cm and involving multiple viscera.
  
  
  METHODS
  Data were retrospectively collected from patients with GISTs treated at the Singapore General Hospital and the National Cancer Centre Singapore over a 15-year period. Standard resection of GIST without any additional organ removal was termed as a single organ resection (SOR). If the tumour was adjacent to another organ, necessitating the removal of more than one organ, the procedure was defined as a multivisceral resection (MVR). We aim to evaluate the role of MVR in the management of large GISTs.
  
  
  RESULTS
  A total of 187 patients underwent curative surgery for GIST between January 2000 and January 2014. Of the 187 patients, 40 (21%) underwent MVR whereas 147 (79%) had SOR. Patients in the MVR group had significantly larger tumour sizes (P < 0.001) yet R0 and R1 resection was achieved in all patients, and no intra-peritoneal rupture was reported. On comparison of MVR versus SOR groups, there was no significant difference in in-hospital morbidity and mortality.
  
  
  CONCLUSIONS
  MVR may be required to achieve negative margins in patients with large GISTs, and can be performed with acceptable morbidity and mortality.
authors.affiliation: Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.
authors.forename: Jolene Si Min
authors.initials: JSM
authors.lastname: Wong
authors.affiliation: Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.
authors.forename: Grace Hwei Ching
authors.initials: GHC
authors.lastname: Tan
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: BKP
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: Mrinal
authors.initials: M
authors.lastname: Kumar
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.
authors.forename: Melissa Ching Ching
authors.initials: MCC
authors.lastname: Teo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000473:pathology* / Q000601:surgery*; D046152:Gastrointestinal Stromal Tumors / Q000208:ethnology / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D009017:Morbidity; D009026:Mortality; D020360:Neoadjuvant Therapy / Q000379:methods; D011184:Postoperative Period; D012008:Recurrence; D012189:Retrospective Studies; D012846:Singapore / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
keywords: gastrointestinal stromal tumor; multivisceral resection; surgical oncology; upper gut