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The Difficult GIST: Surgical Approach and Treatment Strategies
Brandice T. Durkan^*, Edward H. Phillips, Miguel Burch

Surgery, Cedars Sinai Medical Center, Los Angeles, CA

Gastrointestinal stromal tumors (GISTs) are the most common menenchymal tumors of the GI tract. With surgery alone, 50%of patients develop recurrent disease. Tumor size >5cm, Mitotic Index >5/50 high powered field, and location outside the stomach predict higher recurrence. The ACOSOG Z9001 trial demonstrated that one year of Imatinib prolonged recurrence-free survival. The Memorial Sloan Kettering Cancer Center nomogram predicts recurrence free survival in the absence of Imatinib. These case presentations illustrate identification and surgical management of technically challenging gastric GISTs. Application of the nomogram aids in patient selection for adjuvant therapy with Imatinib.

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