Editing GIST (section)

== '''Primary surgery''' ==

* Indications:
** Anything resectable and not      meeting criteria for close observation
** Absence of prohibitive      comorbidities and with a life expectancy of more than a few years
* Unresectable if infiltration     of the coeliac trunk, SMA or portal vein
* R0 local resection, intact     capsule, negative microscopic margin. No role for lymphadenectomy. No     specific margin required, just R0.
* Be careful not to spill     tumour - will result in peritoneal seeding and recurrence in 100% of     patients
* Also tumours are very     vascular - can bleed a lot
* 70% of patients with tumours     >3cm were cured by surgery alone
* GISTs <2cm found     incidentally in surgical specimens do not require further treatment
* Choice of surgery
** Wide local excision
** Enucleation
** Sleeve gastrectomy
** Total gastrectomy
** With or without en bloc      resection of adjacent organs