Actualités chirurgicales des sarcomes, des fibromatoses et des tumeurs stromales gastro-intestinales

Excellent local control rates can be achieved using multidisciplinary approach and combined surgical technics. Better vascular and nervous dissections, use of different flaps and isolated limb perfusion have been determinant. Resection's extent of retroperitoneal sarcoma is still debated, but compartmental surgery seems to achieve better local control. The impact of pre operative radiotherapy will be explored soon in a randomized EORTC trial. Concerning desmoids, authors address the question whether surgery and other aggressive treatments should systematically be part of first-line treatment, as growth arrest occurred in 2/3 of non-operated patients. The objective of on going biological studies is to use molecular findings to individualize the selection of management protocols. In the same way, surgical indications for gastrointestinal stromal tumors evolved: with the development of investigations, more micro-GIST are discovered, rising the question of wait and see policy for some of them. In locally advanced inoperable patients and metastatic patients, imatinib is the standard treatment. Secondary excision of residual disease has been shown to be related to a good prognosis in responding patients to imatinib, but it is still not demonstrated whether this is due to surgery itself or to a selection bias. An ongoing phase III EORTC randomises this secondary surgery after 6 to 12 months of imatinib in responding patients.