Surgical management of metastatic gastrointestinal stromal tumour

Background: Gastrointestinal stomal tumours (GISTs) are the most frequently diagnosed mesenchymal tumour of the gastrointestinal tract. The response of most GISTs to tyrosine kinase inhibitor (TKIs) treatment is spectacular; however progression and/or secondary resistance inevitably occurs with long-term treatment of recurrent or metastatic disease. Randomised studies investigating the potential additive benefit of metastasectomy in addition to TKI treatment unfortunately failed to accrue sufficient patients. Therefore, the apparent benefit of surgery in the setting of metastatic disease is based on retrospective institutional series or extrapolation of data from studies which were not intended directly to investigate the impact of surgery. The aim of this review is to summarise the current literature to inform an approach to the surgical management of metastatic GIST.

Methods: Relevant articles were retrieved from a comprehensive literature search using the PubMed database. Keywords included: GIST, metastasis, surgery, tyrosine kinase inhibitor. No restrictions on publication date were used.

Results: An overview of relevant literature and suggestions for multidisciplinary decision making are formulated.

Conclusions: Our narrative review has identified studies which suggest that surgery may be beneficial in selected patients with metastatic GIST with responsive or stable disease during TKI treatment. Similarly, surgery for isolated clonal proliferative progressive disease may improve progression free survival and delay switch to second-line TKI in some cases.