Surgical resection is the mainstay of treatment for GISTs. GISTs ≥2 cm should be resected, while the surgical management of GISTs <2 cm remains controversial. In GIST, median tumor size at presentation is ≈5 cm.¹

The goal of GIST surgery is complete gross resection with intact pseudocapsule and negative microscopic margins. The abdomen should be examined thoroughly for metastasis, particularly the lesser sac in gastric GIST and the recto-vaginal or -vesical excavation.¹

Endoscopic resections of small GISTs have been performed, but this procedure remains controversial. GISTs are soft, fragile tumors, and endoscopic resection may pose an increased risk of positive margins and tumor spillage.¹

Laparoscopic resections of GISTs are associated with low recurrence rates, but the role of this procedure needs to be investigated further.¹

While resection of higher-risk GISTs (defined as >5 cm with mitotic rate ≥5 per 50 high-powered field (HPF) is not curative, survival after surgery alone is favorable compared with other intra-abdominal sarcomas. In one prospective study, patients who underwent complete resection of primary tumors saw a 5-year disease-specific survival rate of 54%, with median survival of 66 months.¹

Generally, however, local recurrences or metastases develop in approximately half of patients who have undergone potentially curative GIST resection.²

Tumor size, mitotic rate and site are the primary criteria for evaluating risk of GIST recurrence, although KIT mutational status has also been shown to be predictive (See figures in Risk of Recurrence ).³ Understanding the risk of recurrence is essential to ensuring that patients who may benefit from neoadjuvant treatment are not excluded.