Abstract Background: In recurrent GIST whether to consider surgery or to continue on imatinib is still an open question. Aim of Study: To study the role of surgery to treat residual disease versus imatinib mesylate (IM) only to improve pro-gression free survival (PFS) and overall survival in recurrent gastrointestinal stromal tumour (GIST) patients who are responding to imatinib mesylate. Patients and Methods: Three to eight months after starting IM for recurrent GISTs, eligible patients were randomised to two groups: Group A (surgery for residual disease then IM) and Group B (IM treatment alone). In Group A (15 pts), surgery was performed to remove residual macroscopic lesions as completely as possible, and IM treatment continued after surgery. In Group B (15 pts), IM was given alone at a dose of 400mg per day until disease progression. The primary end-point was progression free survival PFS measured from the date IM started. Results: Thirty patients were enrolled in Aswan University Hospital between January 2018 to January 2021. 2-year PFS was 80% in the surgery group and 53.3% in the IM-alone group (p=0.121). Median overall survival (mOS) was 73.3% in the surgery group and 40% in patients with IM-alone group (p=0.065). Conclusions: Excision of recurrent GIST may improve the outcome of recurrent GIST patients who respond to IM.