Journal: Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery
This review article uses gastrointestinal stromal tumor (GIST) as a model to illustrate the evolution of solid tumor management from locally focused surgery to multidisciplinary, precision, full-course care.
Key points:
- Shift in surgical role: The surgeon is reframed from a purely technical operator (“how to resect”) to a strategist and coordinator responsible for perioperative, lifelong management—integrating oncologic outcomes with function, mental health, and quality of life.
- Perioperative framework: Perioperative management is defined as continuous care around elective surgery, structured into three tightly linked phases:
- Preoperative: Risk/status assessment, decision-making, and preparation. This includes evaluating resectability, patient comorbidities, and integrating systemic therapy plans based on current guidelines and expert consensus.
- Intraoperative: Anesthesia, surgical execution, and monitoring, emphasizing precise, oncologically sound resection while preserving organ function and minimizing physiologic stress.
- Postoperative: Prevention and management of complications, early rehabilitation, and long-term functional recovery, framed as part of “full-course” oncologic care rather than a short recovery window.
- Evidence-based and multidisciplinary: Throughout all phases, the article stresses guideline-driven decisions and close collaboration among surgeons, medical oncologists, anesthesiologists, pathologists, radiologists, and rehabilitation/psychosocial teams.
- Goals of modern GIST care:
- Maximize oncologic efficacy (adequate resection, appropriate systemic therapy).
- Preserve physiologic function and organ integrity.
- Support psychological well-being and long-term quality of life.
- Conceptual evolution: Management of GIST is presented as embodying the broader philosophical shift in surgery from “treating the disease” to “treating the person,” with perioperative full-course management as the core operational model.