靶向治疗时代胃肠间质瘤的外科理念

Surgery management for patients with gastrointestinal stromal tumor in the era of targeted therapy

胃肠间质瘤(GIST)是胃肠道最常见的间质肿瘤。长期以来外科治疗是首选也是惟一的治疗手段,随着GIST靶向治疗的到来,外科治疗模式也不断发展。无论是手术原则、手术技术、手术时机,还是手术联合靶向治疗为主的多学科治疗模式,都在循证医学的基础上进行了细化和发展。外科完全切除仍是原发局限可切除GIST治疗的金标准。而对于进展期GIST,靶向治疗的介入彻底改变了此类病人的预后。对伊马替尼治疗有效的进展期GIST病人,联合外科手术切除为主的综合治疗模式是目前研究的热点。

Abstract Gastrointestinal stromal tumors （GIST） are the most common mesenchymal tumor of the gastrointestinal tract. For long time, the only proven therapy was surgery. The use of imatinib for targeted therapy has marked a new era in treatment. The surgical management of GIST has rapidly changed in the era of targeted therapy, and gotten advances in surgical principle, surgical technique and time of surgery, based on evidence-based medicine. Muhidisciplinary approaches included targeted treatment and surgical treatment are the future to successfully treat patients with GIST. Complete resection without tumor rupture is still gold standard of curative treatment for localized, resectable, primary disease. In advanced patients, imatinib has been the standard treatment. For patients with advanced GIST responsive to imatinib, combined surgical plus targeted therapy may be most effective and improve survival.