Surgeon's role for gastric gastrointestinal stromal tumor in imatinib era

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor arising in the stomach, which is characterized by the protein-tyrosine kinase KIT (CD117) expression.Historically, surgical resection has been the mainstay of the curative treatment for localized primary tumors.However, more than an half of the patients with GISTs subsequently develop recurrence or metastasis.The discovery of the molecular pathogenesis of GIST led to the remarkable development of the molecular-targeted therapy with imatinib mesylate, a specific tyrosine kinase inhibitor, and the clinical management of GISTs has rapidly evolved during the last decade.As imatinib has demonstrated significant response in most metastatic GIST, it became the standard first line treatment in patients with metastatic or unresectable GISTs.Nonetheless, treating GIST with a single agent alone is proven to have many limitations because of development of imatinib resistance.Surgical resection still remains the only chance for a cure in GIST treatment.A key strategy for prolonging the survival of patients with GIST is to improve the outcome of surgery.Imatinib use in the GIST management may contribute to surgeons' success in attaining this objective.It is clear that GIST is a complex disease, and a multidisciplinary approach with effective integration of surgery and targeted therapy is crucial to offer a better prognosis to the patients.