Individual surgery for gastric gastrointestinal stromal tumors.

The management of gastric gastrointestinal stromal tumors (GIST) is complex. Local tumor resection with disease-free resection margins without lymphadenectomy is the treatment of choice for primary non-metastatic tumors. This can be achieved with several techniques including wedge resection, transgastric resection, partial gastrectomy, total gastrectomy, and multivisceral resection. Open and minimally invasive surgical approaches can be considered. We describe the technical steps of the aforementioned procedures in relation to tumor size, tumor location (especially at or near the gastro-esophageal junction or pylorus), pattern of exophytic or intraluminal growth, adherence to surrounding structures, and other tumor-associated factors. Challenging situations in gastric surgery for GISTs are also discussed and categorized according to a classification of intraoperative complexity (1 [easy] to 4 [very difficult]). On the basis of this classification, we divided all patients with an indication for gastric GIST surgery into appropriate groups.