Objective: Imatinib has dramatically altered the options for management of patients with gastrointestinal stromal tumours. However, it has become clear that secondary resistance to the drug develops during long-term therapy. The purpose of our study was to retrospectively analyze safety and long-term outcomes in Chinese patients with recurrent or metastatic GISTs treated with imatinib preoperatively. Methods: Between June 2003 and June 2011, 22 patients underwent surgery for recurrent or metastatic GISTs after preoperative treatment with imatinib. Results: Complete resection was accomplished in 8 of the 10 responsive disease (RD) patients (80%), and in 3 of the 12 patients (25%) who had progression disease (PD). The amount of blood loss during the operation in PD patients was higher than in RD patients. There was 1 hospital death in PD group related to surgery, while the other patients recovered with conservative therapy because complications were mild. The difference in median PFS between patients with RD and those with PD was significant (24.8 vs. 2.81 months, P<0.001). The difference in 2-year OS rate between patients with RD and those with PD was not significant (100% vs. 87.5%, P>0.05). Conclusions: Our study indicates that surgical intervention can improve the PFS of Chinese patients with recurrent or metastatic GISTs responsive to imatinib, but does not prolong OS as well as in patients who develop imatinib resistance. Surgical resection following imatinib treatment is feasible and can be considered for patients with advanced GISTs responsive to imatinib. Objective: Imatinib has dramatically altered the options for management of patients with gastrointestinal stromal tumours. However, it has become clear that secondary resistance to the drug develops during long-term therapy. The purpose of our study was to retrospectively analyze safety and long-term Results in Chinese patients with recurrent or metastatic GISTs treated with imatinib preoperatively. Methods: Between June 2003 and June 2011, 22 patients underwent surgery for recurrent or metastatic GISTs after preoperative treatment with imatinib. Results: Complete resection was accomplished in 8 of the 10 responsive disease (RD) patients (80%), and in 3 of the 12 patients (25%) who had progression disease (PD). The amount of blood loss during the operation in PD patients was higher than in RD patients. There was 1 hospital death in PD group related to surgery, while the other patients recovered with conservative therapy because complications were mild. The difference in median PFS bet ween patients with RD and those with PD was significant (24.8 vs. 2.81 months, P <0.001). The difference in 2-year OS rate between patients with RD and those with PD was not significant (100% vs. 87.5%, P > 0.05). Conclusions: Our study indicates that surgical intervention can improve the PFS of Chinese patients with recurrent or metastatic GISTs responsive to imatinib, but does not prolong OS as well as in patients patients who develop imatinib resistance. Surgical resection following imatinib treatment is feasible and can be considered for patients with advanced GISTs responsive to imatinib.