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Surgery and Other Procedures for Gastrointestinal Stromal Tumors
Surgery is often the main treatment for gastrointestinal stromal tumors (GIST) that haven’t spread. The goal of the surgery is to remove all of the cancer.
The type of surgery and whether surgery is an option depends on the location, spread, and size of the tumor. If surgery is not an option, other procedures might be offered to treat GISTs.
Surgery for GIST
Different surgeries are used to treat GISTs depending on whether they are completely or partially resectable (removable), unresectable (unremovable), and/or metastatic (spread to distant sites).
No matter what type of surgery is done, it's very important that it is done by a surgeon experienced in treating GISTs.
GISTs are often delicate tumors, and surgeons must be careful not to open the outer lining that surrounds them (known as the capsule), because it might increase the risk of the cancer spreading or coming back after treatment. GISTs also tend to have a lot of blood vessels, so your surgeon has to be careful to control any bleeding from the tumor.
For more information about finding a surgeon, see Choosing a Cancer Doctor.
If the tumor is small, it often can be removed along with a small area of normal tissue around it.
Doctors do their best to avoid having the tumor burst or tear during surgery by removing it in one piece. This is done through a cut (incision) in the skin. Unlike many other cancers, GISTs rarely spread to the lymph nodes, so removing nearby lymph nodes is usually not needed.
Laparoscopic surgery
For some small cancers, laparoscopic surgery, also called minimally invasive or keyhole surgery, is an option. Instead of making a large incision in the skin to remove the tumor, several small ones are used.
The surgeon inserts a thin, lighted tube with a camera on the end (a laparoscope) through one of them. This lets them see inside the belly. Long, thin surgical tools are used through other incisions to remove the tumor.
Because the incisions are small, patients usually recover more quickly from this type of surgery than from traditional surgery that requires a longer incision. This procedure can only be used for small tumors in certain locations.
If the tumor is large or growing into other organs, the surgeon might still be able to remove it entirely. To do this, parts of organs, such as a section of the intestines, might need to be removed. The surgeon might also remove tumors that have spread elsewhere in the abdomen, such as the liver.
Another option for tumors that are large or have grown into nearby areas might be to take the targeted drug imatinib (Gleevec) or avapritinib (Ayvakit) first, typically for at least several months. This is called neoadjuvant treatment and can often shrink the tumor, making it easier to remove with surgery.
Surgery is not a common treatment for a GIST that has metastasized (spread) to other parts of the body. But surgery might be used in some cases. These include metastatic GISTs that:
- Have responded well to targeted drugs, where one or more tumors left after targeted drugs might be removed completely with surgery
- Have only spread to a few areas and can be safely removed with surgery
- Are bleeding or have caused a blockage or hole in the GI tract that can be fixed with surgery
No large studies have been done to show how helpful surgery is for people with metastatic GISTs. If your doctor offers this surgery, be sure you understand the goals and possible side effects.
If the tumors are in the liver and would be hard to remove, other options might include different types of local treatments, such as ablation or embolization (see below).
Other non-surgical procedures for GIST
Some people might have tumors that can’t be removed with surgery, or they might not be healthy enough to tolerate the surgery that would be recommended. In these cases, sometimes other procedures might be helpful to control tumor growth.
Ablation
Ablation is the destruction of tumors using extreme temperatures or chemicals. It can sometimes be used to destroy some small GISTs that have spread to the liver.
Because ablation often destroys some of the normal tissue around the tumor, it might not be a good choice for treating tumors near important structures, such as major blood vessels or ducts in the liver.
There are several types of ablation:
- Radiofrequency ablation (RFA), which uses high-energy radio waves to heat the tumor and destroy cancer cells
- Ethanol (alcohol) ablation, where concentrated alcohol is injected directly into the tumor to kill cancer cells
- Microwave thermotherapy, where microwaves transmitted through a probe placed in the tumor are used to heat and destroy the cancer cells
- Cryosurgery (cryotherapy), which destroys a tumor by freezing it using a thin metal probe.
What to expect
Usually, you don't need to stay overnight in the hospital for this type of treatment.
Ablation can often be done without surgery. A needle or probe is guided into the tumor through the skin using an ultrasound or CT scan. This might be done with general anesthesia (where you are in a deep sleep) or with conscious sedation (you are awake but sleepy).
Sometimes it is done during surgery to be sure the treatment is aimed at the right place.
Possible side effects
Possible side effects after ablation therapy include abdominal (belly) pain, infection in the liver, and bleeding into the chest cavity or abdomen. Serious complications are uncommon, but they can happen.
Embolization
Embolization is a procedure in which the doctor tries to block or reduce the blood flow to cancer cells in the liver.
The liver is unusual in that it has 2 blood supplies. Most normal liver cells are fed by branches of the portal vein, whereas cancer cells in the liver are usually fed by branches of the hepatic artery.
Blocking the branch of the hepatic artery feeding the tumor helps kill off the cancer cells, but it leaves most of the healthy liver cells unharmed.
Embolization does reduce some of the blood supply to the normal liver tissue, so it might not be a good option for some patients whose liver has already been damaged by diseases such as hepatitis or cirrhosis.
What to expect
The main type of embolization used to treat GISTs that have spread to the liver is arterial embolization (also known as trans-arterial embolization or TAE). In this procedure, a catheter (a thin, flexible tube) is put into an artery through a small cut in the inner thigh and threaded up into the hepatic artery in the liver.
A dye is usually injected into the bloodstream to help the doctor see the path of the catheter via angiography, a special type of x-ray. Once the catheter is in place, small particles are injected into the artery to plug it up.
Embolization can also be done by injecting tiny radioactive spheres into the hepatic artery (radioembolization), or by giving chemo directly into the artery just before plugging it up (chemoembolization). But it’s not clear that either of these techniques is better than TAE.
This might be done with general anesthesia (where you are in a deep sleep) or with conscious sedation (you are awake but sleepy).
Typically, you won't have to stay overnight in the hospital for an embolization procedure.
Possible side effects
Possible complications after embolization include abdominal pain, fever, nausea, infection in the liver, gallbladder inflammation, and blood clots in the main blood vessels of the liver.
Because healthy liver tissue can be affected, there is a risk that liver function will get worse after treatment. This risk is higher if a large branch of the hepatic artery is embolized. Serious complications are not common, but they are possible.
More information about surgery
For more general information about surgery as a treatment for cancer, see Cancer Surgery.
To learn about some of the side effects listed here and how to manage them, see Managing Cancer-related Side Effects.
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- References
Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).
Awad A, Pal K, Yevich S, et al. Safety and efficacy of percutaneous image-guided ablation for soft tissue sarcoma metastases to the liver. Cancer. 2024;130(15):2703-2712.
Kobayashi K, Szklaruk J, Trent JC, et al. Hepatic arterial embolization and chemoembolization for imatinib-resistant gastrointestinal stromal tumors. Am J Clin Oncol. 2009;32(6):574-581.
National Cancer Institute. Gastrointestinal Stromal Tumors Treatment. Accessed at https://www.cancer.gov/types/soft-tissue-sarcoma/hp/gist-treatment-pdq on December 4, 2025.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Gastrointestinal Stromal Tumors Version 1.2025 – April 17, 2025. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/gist.pdf on December 4, 2025.
Raut CP, Hemming M. Management of localized gastrointestinal stromal tumors. UpToDate. 2025. Accessed at https://www.uptodate.com/contents/management-of-localized-gastrointestinal-stromal-tumors on December 4, 2025.
Takaki H, Litchman T, Covey A, et al. Hepatic artery embolization for liver metastasis of gastrointestinal stromal tumor following imatinib and sunitinib therapy. J Gastrointest Cancer. 2014;45(4):494-499.
Last Revised: March 10, 2026
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