Minimally invasive approach in gastrointestinal stromal tumors

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal malignancy of the gastrointestinal tract. The discovery of the mutation in the cKIT tyrosine-kinase and the advent of imatinib-mesylate to target this mutation dramatically improved the prognosis of patients diagnosed with GISTs. Nevertheless, surgical resection remains the cornerstone of treatment in patients with localized disease, and radical resection with negative margins and without tumor rupture is the goal of surgery.

Thirty years after the first laparoscopic resection of a gastric GIST (1), the minimally invasive approach to these tumors has increasingly gained consent among surgeons. Indeed, according to current guidelines (2,3). minimally invasive approaches (i.e., laparoscopic, endoscopic, and robotic) for resection of gastric GIST are suggested for smaller tumors of favorable anatomic locations in referral centers with appropriate experience. More recently, the use of minimally invasive techniques has been proposed also for larger gastric tumors and in extra-gastric locations, and their application in the surgical treatment of GISTs is likely to become wider in the future.

Moreover, the introduction of tyrosine-kinase inhibitors and their use in the preoperative setting, by reducing the volume of the tumor, could make minimally invasive approaches more feasible and safer, beyond the possibility to perform less mutilating surgery with the same oncologic result.

However, some issues are still a matter of debate, especially for GISTs located in anatomically unfavorable sites, such as the esophagus or the rectum: balancing the best oncological result with organ preservation is of crucial relevance in the management of these cases.

In this special series, the authors make an update on the state of the art and open debates in the treatment of GIST. Minimally invasive approaches to non-gastric GISTs are discussed, considering both the technical aspects of the procedures and the oncologic outcomes derived from existing literature (4-6). A narrative review describes the definition and the role of surgical margins in GIST and explores the clinical relevance of minor and major tumor ruptures (7). Finally, an overview on multimodal treatments and new drugs for the management of different stages of disease evidences the necessity of a multidisciplinary approach and of a biology-driven strategy (8).

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Laparoscopic Surgery for the series “Minimally Invasive Approach in Gastrointestinal Stromal Tumors”. The article did not undergo external peer review.

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at https://ls.amegroups.com/article/view/10.21037/ls-22-45/coif). The series “Minimally Invasive Approach in Gastrointestinal Stromal Tumors” was commissioned by the editorial office without any funding or sponsorship. FCMC served as the unpaid Guest Editor of the series. The author has no other conflicts of interest to declare.

Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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Ferdinando Carlo Maria Cananzi