Surgery

All GISTs measuring 2 cm or larger are typically surgically resected. The management of incidentally encountered GISTs measuring smaller than 2 cm remains controversial. There is no evidence for re-excision in patients with a complete resection of all macroscopic disease but microscopically positive margins. Watchful waiting and adjuvant imatinib therapy may be appropriate for these patients.[1,2]

In general, gastric GISTs may be removed by laparoscopic wedge resection, when technically feasible. GISTs rarely involve the locoregional lymph nodes. Thus, extensive lymph node dissection is not indicated unless there is clinically apparent nodal involvement. These tumors may have fragile pseudocapsules, so care must be taken to avoid rupturing the pseudocapsule during surgery, which could result in peritoneal dissemination.