The gist of surgical margins in GIST: a narrative review

The role of margin status as a prognostic factor in gastrointestinal stromal tumour (GIST) remains a matter of debate. It is clear that R2 resection is predictive of poor outcomes, but the impact of R1 versus R0 surgery on survival varies among studies. The occurrence of spontaneous or iatrogenic rupture may explain this heterogeneity in survival and recurrence rates in the literature. Even if residual disease and rupture do have an impact on the prognosis of GIST patients, their role needs to be better clarified, also in the perspective of introducing one or both of these parameters in a proper staging system. Again, the role of margin status should be deeply investigated in order to give clinicians a reliable safety when planning perioperative strategy. Although GIST should be managed by a multidisciplinary team in a referral center and there is no doubt that R0 surgery without rupture of the tumour is the gold standard, in everyday clinical practice this result is not always reasonably achievable: in some cases surgery may leave a microscopic residual and manipulation of large tumours may result in spillage of neoplastic cells in the abdominal cavity. In this review article, the effect of margins itself and the existence of other possible factors influencing prognosis of GIST patients are explored.