Chirurgie des tumeurs stromales gastro-intestinales (GIST) aux stades localisés et métastatiques

Treatment options have evolved rapidly since the discovery of imatinib, which selectively inhibits KIT. Complete resection without rupturing the tumour remains the mainstay of treatment in patients with localized, resectable disease. Rupturing the tumour during resection results in a high risk of local recurrence and should be avoided. It is not recommended to include laparoscopy or lymphadenectomy as standard procedures. Metastatic risk is determined based on tumour size and mitotic count. Imat inib is currently being tested as an adjuvant therapy after the resection of high-risk primary GIST. Imatinib is the first successful systemic therapy for patients with metastatic or unresectable disease. The role of secondary surgery in patients treated with imatinib has not yet been defined, although secondary surgery could benefit patients with advanced primary localized tumours amenable to surgery after imatinib therapy or patients with tumour necrosis accompanied by bleeding and localized progression (to avoid life-threatening complications). For the majority of other metastatic residual lesions, future studies are needed to evaluate the potential benefit since progression-free survival is similar to that reported in non-surgical patients.