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PWE-160 Liver resection in metastatic gastrointestinal stromal tumours

Introduction The benefit, if any and case selection for operation in metastatic GIST has not as yet been evaluated. We report our experience with patients undergoing liver resection for metastatic GIST. Methods From a prospectively held data base spanning 2000–2011 we identified 12 patients who underwent liver resection and cases notes reviewed. Non-parametric statistics were applied. Results The M:F ratio was 5:7. The median age at diagnosis of the primary tumour was 55 yr, range 47–71 yr. The site of primary was: Gastric 6, duodenum 1, small intestine 2, colon 2, rectum 1. In three cases liver metastases were present at diagnosis of the primary and these patients underwent synchronous resection of the primary and liver. In the remainder the median disease free interval was 12 m (2–96 m). In nine cases the pattern of metastatic disease was hepatic alone, two cases had in addition peritoneal disease and both had had percutaneous biopsy of the primary tumour. One case had local recurrence. All but one patient received neoadjuvant chemotherapy with imatinib and in two cases 2nd-line treatment with sunitinib and 1 3rd-line with nilotinib. The median duration of systemic therapy before operation was 18 m (10–84) and systemic therapy was stopped after plateau of response or evidence of progression, non-responders were not considered for resection. Liver resections performed: Right extended 1, right 3, left 1, non-anatomic or segmental 7. Additional visceral resection required in 2 (synchronous primary cases excepted). At a median follow-up time of 43 m from liver resection the status is: NED 7, AWD 3, DOC 1, DOD 1. There was no 30-day mortality. Conclusion The safety of hepatectomy for GIST in the imatinib treated patient is demonstrated. Whether resection of metastatic disease translates into cure, at least in some patients is yet to be proven but it is suggested that the indications for liver resection for metastatic disease might be extended to this disease. Competing interests None declared.