The role of surgery in the multimodal treatment of gastrointestinal stromal tumors

Introduction : Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. Radical resection remains the only curative treatment for primarily resectable disease, whereas the extent of surgery should be carefully tailored to tumor location and biology. Given the heterogeneity in tumor size, location, and biology, the tailored surgical approach based on the imaging and molecular assessments is essential. Aim : This narrative review aims to highlight the evolving role of surgery in the multimodal management of GIST, outlining key principles of operative strategy and integration with systemic therapy. Main findings : Complete R0 resection is the cornerstone of treatment, while lymphadenectomy is unnecessary. Organ-preserving limited resections are oncologically adequate in most cases, provided rupture is avoided. In challenging anatomical sites, neoadjuvant imatinib may improve resectability. For advanced disease, tyrosine kinase inhibitors have reshaped outcomes, and surgery retains a role in selected responders. Conclusion : Surgery continues to play a pivotal role in the treatment of GIST, but optimal outcomes rely on tailoring the extent of resection to tumor size, location, and biology, while integrating systemic therapy where appropriate. The future of GIST management lies in increasingly individualized multimodal strategies, combining precise surgical techniques with targeted molecular approaches.