1. Which gastrointestinal stromal tumors need surgery.
GIST has a high malignant potential, so the clinical diagnosis of GIST, and can be completely resected (except for the combined resection of multiple organs), should be treated by operation.GIST that occurs in the stomach is recommended for surgery in accordance with the following conditions:. tumor is larger than 2cm.The tumor may have a malignant tendency, such as unclear boundaries, ulcers, bleeding, necrosis, and heterogeneous echoes found by endoscopic ultrasonography. If the tumor is smaller than 2cm and has no malignant tendency, it can be closely followed up. However, the small tumor does not mean that there is no possibility of malignancy, the patient should be fully informed of the situation. Complete surgical resection is recommended for GIST that does not occur in the stomach. On the other hand, because palliative surgery can not achieve good results, direct operation should be avoided and preoperative T-KI treatment should be chosen as the standard treatment for metastatic GIST. In addition, extended surgical resection, that is, combined organ resection, is not recommended. Because even if all lesions are resectable, there is no evidence that direct combined organ resection is more effective than TKI-based combined therapy.2. Surgical treatment of gastrointestinal stromal tumors.Surgical resection of GIS T must ensure the complete removal of the tumor, and attention must be paid to avoid the damage of the false capsule of the tumor during the operation. once the tumor appears capsule damage or tumor rupture, it will significantly increase the risk of recurrence and metastasis; in the process of resection, we should pay attention to ensure a sufficient scope of resection, that is, the naked eye cutting edge is negative (there are no tumor lesions visible to the naked eye). If GIST has invaded adjacent organs and tissues, it is best to take targeted drugs for a period of time to evaluate the disease again. If the targeted drugs are not effective, they should be removed together with the involved organs and tissues, and tumor rupture and dissemination still need to be avoided during the operation.For gastric GIST, partial gastrectomy or even total gastrectomy can be performed according to the size and location of the tumor, but local gastrectomy (wedge resection) is sufficient for large gastric stromal tumors. Note that even if the GIST tumor is small, endoscopic resection or simple tumor removal or endoscopic resection of smaller stromal tumors is not recommended in experienced medical centers.If the surgical margin is positive with the naked eye (R2 resection), it is recommended to continue surgical resection. If the cutting edge is positive under the microscope (R1 resection), the scheme is determined according to the risk grade. if it meets the high risk, postoperative TKI adjuvant treatment is recommended, and if low risk, close follow-up is recommended. However, some studies suggest that if imatinib is used after operation, the cutting edge of GIST may not be an important prognostic factor for postoperative recurrence and survival. Since local lymph node metastasis is rare in GIST, lymph node dissection is not routinely performed during operation, but lymph node metastasis in GIST has also been reported.At present, there have been a lot of research and practice of laparoscopic surgery for gastric GIST. Laparoscopic surgery can be used as long as the size of GIST tumor is small and the location is suitable. It is suggested that appropriate extraction techniques should be used during operation to avoid tumor rupture. Compared with open surgery, laparoscopic surgery is in the treatment of GIST. There are similar results and prognosis, and there are advantages such as less pain, less trauma, faster recovery, better cosmetic effect and so on.
