# Beyond Laparotomy: Multimodal Strategies and Emerging Evidence in Minimally Invasive Management of Gastric Gastrointestinal Stromal Tumors

## TL;DR

This review discusses recent advances in minimally invasive surgical techniques for treating gastric gastrointestinal stromal tumors, including laparoscopic and endoscopic approaches.

## Contribution

The paper highlights multimodal strategies and emerging evidence supporting minimally invasive management of gastric GISTs.

## Key findings

- Laparoscopic resection is safe and effective for gastric GISTs larger than 5 cm.
- Laparoscopic endoscopic cooperative surgery combines benefits of laparoscopic and endoscopic techniques.
- Endoscopic innovations have improved the feasibility and safety of endoscopic resection.

## Abstract

Gastrointestinal stromal tumor (GIST) is a type of potentially malignant mesenchymal tumor, thought to arise from the interstitial cells of the gut. More than half of all GIST cases occur primarily in the stomach. Currently, radical resection remains the only curative treatment for this disease. This review is aimed at summarizing recent advances in surgical management and operative techniques for resectable gastric GISTs.

Risk stratification of small gastric GISTs is expected to resolve ongoing debates regarding their management, while artificial intelligence (AI)–assisted imaging shows promise for early detection. In tumors located at unfavorable sites, R1 resection has been shown to achieve oncological outcomes comparable to those of R0 resection, thereby expanding surgical options. The principles of en bloc resection and avoidance of tumor rupture remain critical in intraperitoneal surgery. However, their applicability in endoscopic resection (ER) remains uncertain. Clinical studies have confirmed the long‐term oncological safety and superior short‐term outcomes of laparoscopic resection (LR), even for tumors larger than 5 cm. For LR in challenging locations, expert centers, robotic assistance, and laparoscopic intragastric surgery represent viable alternatives. Innovations and integration of endoscopic techniques have improved the efficiency and feasibility of ER for gastric GISTs, while also reducing complication rates. As an emerging approach, laparoscopic endoscopic cooperative surgery (LECS) combines the advantages of both LR and ER, offering reliable oncological control with a lower incidence of complications.