Surgery

Abstract

The number 1 option for gastrointestinal stromal tumor (GIST) treatment is surgery. Given an organ-sparing approach, it is critical to completely remove the tumor without damaging the pseudocapsule. Removal of the lymph nodes is usually not necessary.

Normally a laparoscopic excision is used on lesions under 5 cm. When using the magnification from a laparoscope, the blood vessels that are manipulated are held to a minimum and the nerves can be preserved as much as possible. This approach has provided good post-operative gastric peristaltic movement. In recent years, a laparoscopic endoscopic cooperative surgery (LECS), which uses both a laparoscope and an endoscope, has been performed in order to prevent excessive resection of the healthy gastric wall. By minimizing the resection of the gastric wall particularly for a GIST that is located at the esophagogastric junction, the cardia can be spared and a proximal gastrectomy can be avoided. The application of LECS was used on lesions that did not include any mucosal lesions since the gastric wall was opened. However, it also became possible to perform a resection on GISTs with ulcerated lesions without scattering tumor cells inside the abdominal cavity by using LECS related techniques, such as an inverted LECS. It is important in terms of oncology to grab the tumor directly and avoid contact with organs inside the abdominal cavity with mucosal lesions.

A post-operative follow-up is performed depending on the risk category assigned by the National Institutes of Health (NIH). For high risk or clinically malignant GIST cases, a CT scan follow-up is appropriate for the first 3 years once every 4–6 months, and then once a year until the 10th year after surgery.