Overall survival rates are similar with watchful waiting and resection in the case of gastrointestinal stromal tumors (GISTs) measuring less than 3 cm in size, according to a new study published in the American Journal of Surgery.

“This decision to operate on tumors within this size category should be made after consideration for symptomatic status and imaging features,” Dhruv J. Patel, BS, and the coauthors of the study said.

The malignant potential of small GISTs is limited. However, the safety and efficacy of expectant management in patients with small GISTs have not been thoroughly investigated. Expectant management, also known as watchful waiting, is defined as closely monitoring a patient’s condition without giving treatment unless symptoms appear or change, or there are changes in test results.

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Here, a team of researchers led by Marshall S. Baker, MD, MBA, identified 1330 patients, aged 65 years and younger with GISTs smaller than 3 cm in size. Of those, 966 had gastric GISTs and 1196 underwent resection, while 134 underwent expectant management. 

The researchers found that there was no difference in 5-year overall survival rates between patients who underwent expectant management and those who were treated with resections.

GISTs are the most common type of mesenchymal abnormal cell growths of the gastrointestinal tract. While they are mostly found in the stomach and small intestine, they can also occur in the esophagus, colon, and rectum. 

Radical and complete surgical resections are treatments for GISTs that offer patients the best chance for complete remission, the authors said. This is the case even for very small GISTs. The overall survival benefits of resections over expectant management had not been investigated thus far.


Patel DJ, Bunn C, Kulshrestha S, et al. Small-sized gastrointestinal stromal tumors: is there an association between expectant management and overall survival? Am J Surg. Published online December 15, 2021. doi:10.1016/j.amjsurg.2021.12.015