Surgery Combined with Long-Term Imatinib Treatment for Patients with Recurrent or Metastatic Gastrointestinal Stromal Tumors

The first-line treatment for recurrent or metastatic gastrointestinal stromal tumors (GISTs) is imatinib, but the benefit of surgical intervention has not been determined. Surgery combined with long-term imatinib treatment (> 10 years) has rarely been reported. Patients with recurrent or metastatic GISTs who received surgery combined with long-term imatinib treatment (> 10 years) were included in this study. The demographic, surgical, and clinicopathologic data were retrospectively collected and analyzed. Five patients (three men and two women) with a median age of 47 (range 37–72) years were included. The primary tumor was located in the stomach and small intestine in three and two patients, respectively. Four patients who received complete resection (R0) had a single recurrent tumor. The remaining patient had more than two recurrent lesions, and the operation was done with gross residual disease (R2 resection, > 90% of the tumor bulk removed). All patients received more than 10 (median 13.50, range 12.30–13.67) years of imatinib treatment after resection of recurrent tumors. Two patients received a reduced dose of imatinib, and the remaining received 400 mg/day. The median follow-up was 17.0 (range 14.58–20.17) years since the primary tumor was resected. Two patients developed a tumor recurrence after 11.58 and 12.0 years of imatinib treatment, respectively. Surgical intervention may be beneficial when combined with long-term imatinib treatment for selected patients with recurrent or metastatic GISTs but should be further investigated.