Serving Pasadena, CA

GIST Specialist for Pasadena, CA

A gastrointestinal stromal tumor that has reached the liver is not a closed case. Targeted therapy establishes control, and surgery finishes what the drug cannot. Joshua Ellenhorn, MD, FACS assesses when an operation adds something and when it does not.

Assessment of metastatic and recurrent GIST for surgery
Clinical Professor of Surgery, Cedars-Sinai Medical Center
Resection and ablation of liver deposits
Works alongside your existing oncology team

Schedule a consultation Call (310) 356-3792

Metastatic gastrointestinal stromal tumor assessment for Pasadena, CA patients

LiverThe commonest site of GIST spread, then the peritoneum

Drug firstTargeted therapy usually precedes any operation

4 linesEstablished drug options beyond first line imatinib

30 minFrom Pasadena via the 134 and the 101

Metastatic does not mean untreatable

GIST Is the Exception Among Advanced Cancers

For most solid cancers, spread to the liver moves surgery off the table permanently. GIST does not follow that rule, and the reason is the same mutation that caused it. KIT and PDGFRA driven tumors respond to targeted therapy in a way that is genuinely unusual, and that response frequently converts widespread disease into something limited enough to operate on.

The sequence matters more than the individual steps. Imatinib first, because it acts on every deposit simultaneously and no operation can. Then reassessment, because what the drug leaves behind is a much better defined target than what it started with. Then surgery or ablation for the residual disease, if what remains is limited and the patient is fit.

Where this goes wrong is in both directions. Operating too early, into active and responsive disease, achieves less than continuing the drug. Never reassessing for surgery at all leaves patients on medication indefinitely when resection of a small number of deposits might have consolidated the gain. Judging which situation applies is the question a surgical opinion answers.

Meet Dr. Ellenhorn

GIST specialist reviewing liver imaging with a patient in Los Angeles

When surgery helps

Reading the Situation Before Deciding to Operate

These are the patterns that determine whether an operation would add anything. The distinction between focal and generalised progression is the one most worth understanding.

Situation	What it means	Usual approach
Responding well on first line therapy	Deposits shrinking across the board	Continue the drug. Reassess for surgery once the response plateaus rather than operating into an active response
Stable, limited residual disease	A small number of deposits persisting after a good response	Resection or ablation may consolidate the gain. Medication is generally continued afterwards
Focal progression	One deposit growing while the rest remain controlled	Removing or ablating that single site can extend the useful life of the drug you are already on
Generalised progression	Multiple deposits growing at once	A change of drug rather than an operation. Sunitinib, then regorafenib, then ripretinib
PDGFRA D842V tumor	A subtype that never responds to imatinib	Avapritinib is specifically effective here. Recognising the subtype prevents months lost on the wrong drug
Peritoneal disease only	Spread across the abdominal lining rather than the liver	Harder to image and to resect completely. Drug therapy leads, and surgery is selective

Targeted therapy is usually continued after resection of metastases rather than stopped, since stopping tends to permit regrowth of microscopic disease. That decision sits with your medical oncologist.

CT imaging of gastrointestinal stromal tumor liver metastases

How liver deposits are treated

Resection, Ablation, or Both

Liver deposits from GIST are approached with the same tools used for other liver tumors, chosen by size and position rather than by preference.

Resection removes the deposit with a margin of surrounding liver. It is the most reliable option for larger deposits and for those the surgeon can reach without sacrificing important structures. The liver tolerates the loss of a substantial proportion of its volume and regenerates, which is what makes this feasible at all.

Ablation destroys the deposit in place using heat, most commonly microwave or radiofrequency energy delivered through a needle. For small deposits in accessible positions it achieves comparable control with markedly less recovery, and it can be repeated. Deposits sitting against major vessels or bile ducts are less suitable, because the same heat that treats the tumor can damage those structures.

In practice many patients receive both in one operation: resection where it is needed and ablation where it is sufficient. The aim is complete treatment of what the drug has left, not maximal surgery.

In the operating room

The Primary Operations, on Record

Recordings of real GIST resections narrated by the surgeon who performed them. The primary tumor still has to be handled correctly even when disease has spread.

Laparoscopic Resection of a Gastric GIST

A gastric GIST removed through small incisions with the capsule kept intact.

Gastric GIST Resection: A Simplified Approach

A refined approach that shortens operating time and recovery.

Robotic Resection of a Duodenal GIST

Duodenal GIST removed robotically with the pancreas and bile duct preserved.

Worth asking for

Has Anyone Reassessed You for Surgery?

Patients doing well on targeted therapy are often never reviewed surgically again. If your disease has been stable or responding for a year or more, it is reasonable to ask whether resecting what remains would consolidate that.

Request a surgical assessment

Credentials

Certifications and Appointments

Two American Board of Surgery certifications, a Cedars-Sinai teaching appointment, and membership of the societies that publish the treatment guidelines for advanced GIST.

American Board of Surgery, certified in General Surgery
American Board of Surgery, certified in Colorectal Surgery
California State Medical License
Florida State Medical License

Your surgeon

Joshua Ellenhorn, MD, FACS

Dr. Ellenhorn is a surgical oncologist and Clinical Professor of Surgery at Cedars-Sinai Medical Center, and a collaborative member of the Samuel Oschin Comprehensive Cancer Institute.

Advanced GIST is where surgical oncology and medical oncology have to work as one rather than in sequence, because the value of an operation depends entirely on what the drug has already achieved. A surgeon who does not follow the response data closely will operate at the wrong moment, and an oncologist without a surgical partner may never reassess at all. Practising within a comprehensive cancer institute is what makes that coordination routine.

He is certified by the American Board of Surgery in General Surgery and in Colorectal Surgery, a Fellow of the American College of Surgeons, and a member of the Society of Surgical Oncology and the American Society of Clinical Oncology. He practises with the Surgery Group of Los Angeles.

Dr. Joshua Ellenhorn, MD, FACS, GIST surgeon serving Pasadena, CA

For patients already in treatment

Questions for Your Oncology Team

These are the questions that determine whether surgery has a role in your case. Ask them where you are being treated.

What is my current pattern of response on imaging?
Is any progression focal or generalised?
What mutation subtype do I have?
Which line of therapy am I on, and what comes next?
Has my case been reviewed for surgical resection since starting the drug?
Are my remaining deposits limited enough to resect or ablate?
Would I continue medication after an operation?
Is there a trial that would be appropriate for me?

Patient experience

What Patients Say

Reviews left by patients treated by Dr. Ellenhorn at the Surgery Group of Los Angeles.

★★★★★
I was very pleased with the office staff, they were always very pleasant and helpful. I was very impressed with Dr. Ellenhorn as well. He was very friendly and addressed all my concerns regarding my surgery and aftercare and follow up.
Terry Jackson

★★★★★
Very kind stuff, great service. Dr Joshua Ellenhorn is a very calm doctor who takes time with his patient.
Anita Lukacevic

Getting here

Thirty Minutes From Pasadena

The 134 west to the 101 south through the Cahuenga Pass, then Highland down and west along 3rd Street. From the southern end of the city and the Old Pasadena area, the 110 to the 101 often runs better. From the eastern side toward Arcadia and Duarte, the 210 to the 134 is the natural line.

The office is in the medical plaza attached to Cedars-Sinai Medical Center. For advanced disease this matters practically: imaging, pathology, surgical consultation, and the operating rooms are in one building, and the response assessments that decide the timing of surgery are read in the same place they are discussed.

Most Pasadena patients with metastatic GIST keep their existing medical oncologist for drug therapy and trial access. The surgical assessment sits alongside that rather than replacing it.

GIST Specialist

8635 W 3rd St, Suite 880W
Los Angeles, CA 90048

(310) 356-3792

Monday to Saturday, 11:00am to 8:00pm
Closed Sunday

Get directions

Pasadena patient questions

Frequently Asked Questions

My GIST has spread to the liver. Is surgery still possible?

Often yes, though not immediately and not for everyone. The usual sequence is targeted therapy first to establish control, then reassessment. If the disease responds and what remains is limited, resection or ablation of the liver deposits can be worthwhile. Metastatic GIST is one of the few cancers where that sequence genuinely applies.

Why not operate straight away?

Because operating into active, widely responsive disease usually achieves less than the drug does. Imatinib frequently produces a substantial response across every deposit at once, which no operation can. Surgery becomes useful for what the drug cannot finish, which is a different and much better defined target.

What is focal versus generalised progression?

A meaningful distinction. If one deposit grows while everything else stays controlled, that is focal progression and removing or ablating that single site can extend the benefit of the drug you are on. If everything grows at once, that is generalised progression and the answer is a change of drug rather than an operation.

What happens if imatinib stops working?

There is a defined sequence. Sunitinib is second line, regorafenib third, and ripretinib is available beyond that. Avapritinib is specifically effective for PDGFRA D842V tumors that never responded to imatinib. Running out of options is far less common than patients fear.

Can I stop the medication after my liver deposits are removed?

Generally no, and this matters. Targeted therapy is usually continued after resection of metastases, because stopping tends to allow regrowth of microscopic disease. That decision belongs with your medical oncologist, and it should be explicit rather than assumed.

Is ablation as good as surgery for liver deposits?

For small deposits in accessible positions, ablation achieves similar control with less recovery. For larger ones or those near major vessels or bile ducts, resection is more reliable. The two are complements rather than competitors, and often both are used in one patient.

How far is your office from Pasadena?

Thirty to thirty five minutes. The 134 west to the 101 south, then Highland down and west along 3rd Street. The 110 to the 101 is the alternative from the southern end of the city.

Will I keep my oncologist at a comprehensive cancer centre?

Yes, and that is the sensible arrangement. Drug therapy, response assessment, and any trial access stay with them. The surgical question, whether an operation would add anything to what the drug has achieved, is what is answered here.

Stable on Treatment? Ask Whether Surgery Would Consolidate It.

Metastatic GIST responds to targeted therapy in a way most cancers do not, and resecting what remains can build on that. If nobody has reassessed you surgically since you started the drug, it is worth doing.