Salvage surgery for patients with recurrent gastrointestinal sarcoma - Prognostic factors to guide patient selection

BACKGROUND. Gastrointestinal sarcomas are rare stromal tumors and most are classifiable as malignant gastrointestinal stromal tumors. They have a high propensity for intraabdominal recurrence. It is unclear whether there is a survival advantage from reoperation for recurrent disease or if surgery sh ould be confined to symptom relief. The authors have attempted to identify features that may allow the selection of patients most likely to benefit fr om reoperation. METHODS, Retrospective univariate and multivariate analyses of 60 patients with recurrent gastrointestinal sarcoma, accrued from a prospective data ba se between July 1982 and September 1995, were performed. RESULTS. Initial recurrence was evident by a median of 20 months from prima ry resection. Most patients (85%) had an initial symptomatic recurrence. Lo cal recurrence was seen in 76% of patients, but in half of these synchronou s hepatic metastases were present. None had disease outside of the abdomen. Complete resection of recurrent disease was possible in only one-third of cases. Median survival after surgery for recurrence was 15 months, but was longest for patients whose recurrence took the form of liver metastases in the absence of disease elsewhere. In multivariate analysis of postrecurrenc e survival, the only significant determinant of survival was the length of the disease free interval between the initial operation and recurrence. CONCLUSIONS. Survival following recurrence of a gastrointestinal sarcoma is largely determined by the tumor biology, one manifestation of which is the disease free interval. Except for patients with a long disease free interv al, surgery should be reserved largely for symptom control. Cancer 2000;88: 66-74. (C) 2000 American Cancer Society.