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Ieve negative microscopic margins; positive margins are associated with a risk of peritoneal recurrence (35). In one case series (36), the disease-specific survival rate at five years for resectable gist was 54%; median survival was 66 months. safe buy viagra canada The use of laparoscopic resection is controversial. buy generic viagra While it is a potentially useful technique for incidental small gastric gists (smaller than 2 cm) when the risk of tumour rupture is low, there is currently no consensus on the appropriate use of laparoscopy. Additional data are required. generic viagra online Lymphadenectomy is not required when the diagnosis of gist has been established. eli lilly viagra 5mg Neoadjuvant imatinib should be considered for ‘functionally unresectable’ gist, where surgery would result in significant morbidity or loss of organ function, with the purpose of downsizing the tumour and preserving organ function (37–39). Examples include tumours near the gastroesophageal junction that would otherwise require total gastrectomy, duodenal gist requiring pancreaticoduodenectomy (whipple procedure) or a low rectal gist requiring abdominoperineal resection. Neoadjuvant imatinib, when appropriate, should be initiated promptly. viagra generic Surgery should be performed, ideally in a tertiary care centre, approximately four to 12 months after initiating imatinib when maximal tumour shrinkage has been achieved. generic4all viagra review Follow-up ct scans should be performed every three months; maximal tumour shrinkage is defined as no further shrinkage on two consecutive ct scans. buy viagra cheap Because the risk of significant hemorrhage approximates 5%, a surgeon should form part of the management team making the decision for neoadjuvant treatment. viagra safe liver Imatinib is recommended for borderline unresectable gist (37). buy viagra online cheap free shipping Because there is a potentially small window of opportunity before the gist becomes unresectable in the case of primary resistance, pet scans are recommended at baseline and seven to 14 days after initiation of imatinib in these cases. order viagra online Imatinib is recommended for all patients with unresectable tumours (16,40). In a randomized, open-label trial of 147 patients by demetri et al (40), 54% of subjects had a partial response and 28% had stable disease with imatinib cd mg/day or 600 mg/day. Recommendations: medical oncology there are no mature outcome data on imatinib pretreatment for resectable primary gist (neoadjuvant) and this approach remains investigational. side effect of viagra in long term At present, there is no rationale or evidence to support neoadjuvant. eli lilly viagra 5mg






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