What is the first-line treatment for GIST, and what type of surgery is typically performed if needed?

The first-line treatment for gastrointestinal stromal tumors (GISTs) is surgical resection, and the type of surgery performed typically involves an anatomical resection when feasible. GISTs are known to express the CD117 protein and are often driven by mutations in the KIT gene, which play a significant role in their biology.

Surgical intervention is decisive, as GISTs may not respond well to conventional chemotherapy or radiation therapy, and these modalities are not typically part of the standard management for localized disease. In the case of larger or more complex tumors, a wedging technique may be used to achieve adequate removal of the tumor while preserving as much surrounding healthy tissue as possible. This technique allows for adequate resection of the tumor along with a margin of healthy tissue to decrease the chances of recurrence, even though the optimal margins may vary.

In instances where the tumor cannot be completely resected or if surgical resection is not an option, then targeted therapy, specifically imatinib, becomes the primary treatment pathway. However, if surgical resection is deemed appropriate, it is performed to achieve a definitive cure where possible. Thus, the consideration of surgical options and techniques is central to the management of GISTs, emphasizing the critical role of