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Bachelor of Medicine and Surgery MBChB (UCT).
Fellow of South African College of Surgeons
Diploma in Obstetrics & Gynaecology
Gastrointestinal Stromal Tumour (GIST) Surgery
What is a GIST?
A gastrointestinal stromal tumour (GIST) is a rare type of tumour that originates in the walls of the gastrointestinal (GI) tract. They are the most common type of sarcoma (a tumour of soft tissue) in the digestive system. While GISTs can be found anywhere in the GI tract, they most often occur in the stomach or small intestine.
Symptoms of a GIST can be vague and may include:
Abdominal pain or a feeling of a mass in the abdomen- Gastrointestinal bleeding, which may appear as blood in your stool or vomit
- Anaemia (low red blood cell count) due to chronic bleeding
- Fatigue
- Feeling full after eating only a small amount of food
What is a GIST Excision?
The primary and most effective treatment for a localized GIST (a tumour that has not spread) is surgical removal, or excision. The goal of the surgery is to completely remove the tumour while preserving as much of the surrounding healthy tissue as possible.
The type of surgery performed depends on the size and location of the tumour. The surgeon will remove the tumour along with a small margin of normal tissue around it. Unlike many other types of cancer, GISTs rarely spread to lymph nodes, so it is typically not necessary to remove nearby lymph nodes.
This surgery can be performed using either an "open" or a "laparoscopic" approach.
- Laparoscopic (Minimally Invasive) Surgery: For smaller tumours, a laparoscopic approach is often used. The surgeon makes several small incisions in your abdomen to insert a laparoscope (a thin tube with a camera) and other specialized surgical instruments. This technique generally results in less pain, a shorter hospital stay, and a quicker recovery.
- Open Surgery: For larger or more complex tumours, an open surgical approach with a single, larger incision may be necessary to ensure complete removal of the tumour.
Indications: When is this procedure recommended?
Surgical excision is the standard of care for any GIST that is considered "resectable," meaning it can be safely and completely removed by a surgeon.
- Tumour Size: GISTs larger than 2 cm are generally recommended for removal. Smaller tumours (under 2 cm) that are not causing symptoms may be monitored with regular imaging studies or endoscopy. If they begin to grow or cause symptoms, surgery is recommended.
- Tumour Location: The location of the tumour is a key factor in determining the type of surgery. For example, a GIST in the stomach may be removed using a "wedge resection," where the surgeon removes a wedge-shaped portion of the stomach containing the tumour.
- Response to Targeted Therapy: For very large tumors or those that are difficult to access, targeted drug therapy (such as imatinib, also known as Gleevec) may be used before surgery to shrink the tumour. This can make the surgery easier and safer, increasing the chances of a complete removal. This is known as "neoadjuvant" therapy.
The Procedure: What to expect
- Preparation: Before the surgery, you will be given specific instructions regarding diet and medication. You will need to fast (not eat or drink) for a certain number of hours before the procedure.
- Anaesthesia: The surgery is performed under general anesthesia, meaning you will be asleep and will not feel any pain.
- The Excision: The surgeon will carefully and gently remove the tumour, taking great care not to rupture the tumour's capsule (the outer lining), as this could increase the risk of recurrence. The tumour is removed along with a small margin of healthy tissue.
- Reconstruction: After the tumour is removed, the surgeon will repair the stomach or intestine. This may involve stapling the edges together or sewing them with sutures.
- Closure: The incisions are closed with sutures or surgical glue.
Recovery
The length of your hospital stay and recovery time will depend on the size of the tumour and the type of surgery you had.
- Hospital Stay: Patients who undergo a laparoscopic procedure may go home in 2 to 5 days, while those with an open procedure may require a longer stay of up to a week or more.
- Pain Management: You will be given medication to manage pain at the incision sites.
- Diet: Your care team will guide you through a gradual return to a normal diet, starting with liquids and slowly introducing soft foods.
- Activity: You will need to avoid strenuous activity and heavy lifting for several weeks to allow for proper healing.
Risks and Complications
While GIST excision is a safe and effective procedure, there are potential risks and complications, which your surgeon will discuss with you in detail. These can include:
- Infection or bleeding
- Leakage from the surgical repair site (anastomosis)
- Injury to nearby organs
- The need to convert a laparoscopic procedure to an open procedure
- Tumour recurrence
After surgery, you may also be prescribed targeted drug therapy (adjuvant therapy) to reduce the risk of the tumour returning, depending on its size and characteristics. You will also have regular follow-up appointments with your doctor to monitor your recovery and check for any signs of recurrence.
Please note: The information provided above and on this website is for education and interest purposes only. It is not intended to replace a personal one-on-one consultation, nor is it meant to substitute professional medical advice, diagnose or treat any condition. A consultation with a specialist and qualified health care provider such as Dr. Mitchell or Dr. Munda is essential for correct diagnosis and management, as well as to answer any queries that you may have. Never disregard or delay in seeking professional medical advice due to something you have read on this website. Dr. Mitchell and Dr. Munda take no responsibility for any errors or omissions present on this website and they are not liable for any consequences that may occur from misinterpretation of the information on this website. In the event of uncertainty or an emergency, please visit your nearest casualty.