**5. Conclusions**

actual Incidence is believed to be much higher [22]. The stomach is the most common location for GISTs (70%). The driving force for GIST development is a gain-of-function mutation in

Although the discovery of tyrosine kinase inhibitor imatinib has been the most significant change in GIST treatment over recent years, surgery as the only potentially curative method

Gastric GISTs start their growth in deeper layers, mostly in the smooth muscle layer of gastric wall; expand intra- or extraluminally and eventually produce haematogenous metastasis in solid organs or peritoneum. They can also cause sarcomatosis by perforating into peritoneal

Any patient who is medically fit should undergo complete surgical resection of gastric GIST. However, NCCN and ESMO guidelines recommend endoscopic surveillance for small (<1 cm and <2 cm, respectively) gastric lesions if high-risk features are not present by endoscopic ultrasound investigation (ulcerations (see **Figure 11**), cystic spaces, irregular borders, echogenic foci and heterogeneity). All other cases and patients who do not want to undergo endo-

Unlike for carcinoma, a wide resection margin of healthy tissue is not necessary for GISTs. It is of paramount importance to be meticulous and remove the entire lesion without damaging tumour pseudocapsule or causing tumour spillage or bleeding as this would increase the risk of locoregional recurrence and sarcomatosis. GISTs rarely spread via lymphatics; therefore, lymphadenectomy is not necessary. If noted, enlarged lymph nodes near the tumour can selectively be dissected. Either wedge resection or full-thickness partial gastrectomy is usually sufficient for lesser and greater curvature tumours, whereas a transgastric resection after anterior gastrotomy incision is performed for posterior wall gastric GISTs. Total or subtotal gastrectomy is only required for tumours occupying large portions of the stomach. If the tumour is borderline resectable or a extensive operation

scopic surveillance should be treated by surgical resection [21, 24].

**Figure 11.** Gastrointestinal stromal tumour. Note the umbilicated ulceration.

tyrosine kinase receptor gene *c-KIT* [21].

remains the cornerstone of treatment [23].

cavity [21].

214 Gastric Cancer

Gastric cancer at present remains one of the most difficult oncological problems the surgeon has to deal with. Despite extensive research in novel systemic therapeutic options, surgery is still the only potentially curative treatment. Accumulation of evidence has made surgical treatment of gastric cancer more personalised allowing to select the extent of resection and lymphadenectomy according to specific tumour. Increased skills combined with technological advances have further improved the postoperative function by making minimally invasive approach safe and effective. Even complex procedures like D2 lymph node dissection are nowadays performed laparoscopically in specialised centres. Despite being rare, gastric NETs and GISTs need special consideration when it comes to surgical treatment because these tumours differ from adenocarcinomas in biology and best management. Robotic surgery and hybrid endoscopic surgical procedures will probably have a more prominent role in the future because of their potential advantages over conventional laparoscopic surgery.
