title: What is changing in the surgical treatment of gastrointestinal stromal tumors after multidisciplinary approach? A comprehensive literature's review.
abstract: BACKGROUND
  Gastrointestinal stromal tumors (GIST) represent the most common mesenchymal neoplasms of the gastrointestinal tract. Surgery is the only curative treatment for GIST. The aim of our review was to highlight the changes in the surgical treatment of GIST after the introduction of TKI therapy in a multimodality management (neo-adiuvant or adiuvant setting).
  
  
  METHODS
  We carried out a review of the recent literature about surgical treatment of GIST according to its anatomical location and size according to PRISMA STATEMENT to systematic review. We searched the Cochrane Library, MEDLINE, and EMBASE, limited to the final search date [31/12/2015], limited to English language publications. We used the search terms "GIST" in combination with the terms "surgery" or "multidisciplinary approach" or "TKI therapy" or "neo-adiuvant - adiuvant treatment".
  
  
  RESULTS
  The optimal surgical technique to achieve the best results in terms of Overall Survival, Relapse Free Survival and Disease Free Survival is oncological resection with disease free margins. Proper preoperative staging is essential to decide the surgical approach. Data reported in literature showed that laparoscopic approach to GIST obtains the same oncological results as conventional surgery.
  
  
  CONCLUSIONS
  The medical oncologist, radiologist and surgeon must collaborate to determine the appropriateness of primary surgery, with curative intent, after neoadiuvant therapy or as palliative treatment. Laparoscopy is feasible and safe for small GIST, but there is no international consensus for large GIST yet. The introduction of imatinib as neoadjuvant therapy with the goal of reducing tumor size, minimizes surgical morbidity and, in some cases, makes operable the inoperable cases. In addition, the use of imatinib in the adjuvant setting, to eradicate micrometastases and to prevent recurrence, has shown promising results in reducing relapse rates.
authors.affiliation: Department of Emergency and Trauma Surgery, University Hospital of Parma, Parma, Italy - desimone.belinda@gmail.com.
authors.forename: Belinda
authors.initials: B
authors.lastname: DE Simone
authors.affiliation: Department of General and Emergency Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Ansaloni
authors.affiliation: Department of Emergency and General Surgery, Macerata's Hospital, Macerata, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Sartelli
authors.affiliation: Department of General and Emergency Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Coccolini
authors.affiliation: Department of General Surgery, Maggiore Hospital of Bologna, Bologna, Italy.
authors.forename: Salomone
authors.initials: S
authors.lastname: DI Saverio
authors.affiliation: Department of Specialized, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Pantaleo
authors.affiliation: Department of Specialized, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Maristella
authors.initials: M
authors.lastname: Saponara
authors.affiliation: Department of Specialized, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Margherita
authors.initials: M
authors.lastname: Nannini
authors.affiliation: Department of Emergency and Trauma Surgery, University Hospital of Parma, Parma, Italy.
authors.forename: Harishine K
authors.initials: HK
authors.lastname: Abongwa
authors.affiliation: Department of Medical Sciences, University of Hawaii, Honolulu, HI, USA.
authors.forename: Josephine A
authors.initials: JA
authors.lastname: Napoli
authors.affiliation: Department of Emergency and Trauma Surgery, University Hospital of Parma, Parma, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Catena
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000379:methods; D005770:Gastrointestinal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D046152:Gastrointestinal Stromal Tumors / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D006801:Humans; D000068877:Imatinib Mesylate / Q000627:therapeutic use; D033183:Interdisciplinary Communication; D010535:Laparoscopy; D020360:Neoadjuvant Therapy / Q000379:methods; D009367:Neoplasm Staging; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D065287:Robotic Surgical Procedures / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D000068877:Imatinib Mesylate