A 62-year-old woman undergoes endoscopy for dyspepsia revealing a large submucosal mass in the gastric body. Biopsy of the mass shows spindle cell tumour positive for CD117 (c-kit). CT shows no metastatic disease. What is the initial treatment of choice?
- A Imatinib mesylate 400 mg daily for 12 months before any surgery
- B Radical gastrectomy with D2 lymphadenectomy
- C Surgical resection with en bloc removal of the tumour and intact pseudocapsule ✓
- D Endoscopic mucosal resection regardless of size
Correct answer: C. Surgical resection with en bloc removal of the tumour and intact pseudocapsule
Explanation
Localized resectable gastric GIST is treated primarily with complete surgical excision preserving an intact pseudocapsule, since capsular breach risks peritoneal seeding. Routine lymphadenectomy is unnecessary because nodal spread is rare, making option B wrong. Neoadjuvant imatinib is reserved for locally advanced or borderline resectable tumours, and adjuvant imatinib follows surgery in higher-risk lesions based on mitotic rate and size. EMR is unsuitable for large lesions.
Reference: Sabiston Textbook of Surgery, 21st ed.
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