Abstract: Objective To explore the surgical treatment experience of primary giant gastrointestinal stromal tumors（GIST）(with isolated lesions with a maximum diameter ＞ 10cm).Methods A retrospective analysis was conducted on the clinical and pathological data of 67 patients with primary giant GIST admitted from January 2018 to December 2024.Among them, 35 cases underwent surgical operations after preoperative neoadjuvant therapy (25 effective cases and 10 ineffective cases) (neoadjuvant therapy group).Due to the initial diagnosis assessment expecting radical (R0) resection (13 cases), or preoperative complications (12 cases), or difficulty in obtaining a pathological diagnosis through puncture biopsy (7 cases), 32 cases underwent direct surgery without neoadjuvant therapy (direct surgery group).Compare the general information,tumor condition,surgical condition,postoperative recovery,postoperative pathology,postoperative adjuvant therapy,and recurrence between two groups.Results Comparative analysis revealed that there was no statistically significant difference(P>0.05) between the neoadjuvant therapy group and the direct surgery group in terms of gender,age,primary tumor location,initial maximum diameter,growth type,localized or locally advanced stage,and postoperative follow-up time.The maximum diameters of the tumors before surgery in the neoadjuvant therapy group and the direct surgery group were (12.4±7.1)cm and (18.2±5.0) cm respectively, and the operation times were (125.4±30.6) minutes and (153.0±31.7) minutes respectively. The intraoperative blood loss was (228.3±76.4)ml and (300.3±67.2)ml, respectively. The postoperative hospital stay was (9.1±2.6) days and (11.1±3.2) days, respectively. There was a statistically significant difference between the two groups (P < 0.05).The proportion of laparoscopic surgery in the neoadjuvant therapy group was 17.1%, which was higher than that in the direct surgery group (0), and the difference was statistically significant (P < 0.05). There was no statistically significant difference between the two groups in terms of the proportion of tumor rupture, combined organ resection, postoperative complications and postoperative recurrence (P>0.05).Conclusion Primary giant gastrointestinal stromal tumors can mostly be reduced in size and progression through neoadjuvant therapy,improving the chances of minimally invasive surgery.However,there is also a risk of tumor progression during neoadjuvant therapy leading to increased surgical difficulty or even loss of curative surgical opportunities.

Key words: gastrointestinal stromal tumor;giant;neoadjuvant therapy;surgery