Long-term outcomes after multiorgan resection of primary gastrointestinal stromal tumors

Abstract

Background: Complete resection is the mainstay of therapy for nonmetastatic gastrointestinal stromal tumors (GIST) and may necessitate multiorgan resection (MOR). We evaluated surgical oncological outcomes as well as long-term quality of life (QoL) in patients undergoing MOR or single-organ resection (SOR) for primary GIST. Methods: One hundred fifty-two primary GIST resections performed at Heidelberg University Hospital (2002–2022) were retrospectively analyzed, including subgroup analyses for locally advanced GIST (T3/T4, n = 76). Kaplan–Meier and multivariable Cox regression analyses assessed overall survival (OS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS). QoL was evaluated using standardized questionnaires (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30, Warwick-Edinburgh Mental Well-Being Scale, Fear of Progression Questionnaire, and Primary Care PTSD Screen). Results: One hundred two (67.1%) patients with primary GIST underwent SOR, and 50 (32.9%) underwent MOR. Five-year OS was 87% in the SOR and 95% in the MOR group. Patients in the MOR group exhibited tumors with higher Armed Forces Institute of Pathology risk scores (P = 0.012) and had more complications (P < 0.001), though the severity of complications was similar. Multivariable analyses revealed no statistically significant difference between MOR and SOR regarding OS and DMFS, but MOR was associated with reduced LRFS (P = 0.001). These associations were consistent in subgroup analyses of locally advanced tumors. Long-term QoL after MOR was noninferior to long-term QoL after SOR. Conclusions: MOR is comparable to SOR regarding OS, despite patients undergoing MOR having more prognostically unfavorable tumors. While MOR is associated with increased postoperative morbidity, long-term QoL remains unaffected. Thus, MOR appears oncologically effective when necessary in certain clinical scenarios and does not compromise long-term patient-reported QoL.