For localized intraabdominal or visceral sarcomas including GIST, operative treatment with complete resection of the tumor is the only curative modality and is indicated in all patients that seem medically fit to undergo the procedure.
Only in selected cases of localized GIST, especially in the rectum, where downstaging of the tumor is desirable in order to limit the extent of an operation, will neoadjuvant treatment with thyrosinase kinase inhibitors be instituted for a period ranging from 6-12 months.
Intraabdominal sarcomas can present with an intact serosal covering toward the peritoneal cavity, but in many instances this margin is nonexistent and the tumor has a naked intraperitoneal surface that greatly increases the risk of transperitoneal metastasis.
Tumor rupture, if not already present before operation, should be avoided by meticulous handling of these tumors. All peritoneal surfaces should be examined for potential metastasis.
The extent of resection of the gastrointestinal organ of origin is dependent on the size of the tumor base, its location and other anatomical and physiological aspects. Partial resections are most often sufficient to achieve negative tumor margins.
When surrounding organs have tight adherances to the tumor, an en bloc resection of these organs with the tumor should be performed. Only in selected cases should these patients be treated by laparoscopic procedures.
- The patient is free of macroscopic tumor tissue.