Current surgical management of duodenal gastrointestinal stromal tumors

Table 2 Summary of systematic review and meta-analysis and propensity score matching studies comparing limited resection vs pancreaticoduodenectomy for duodenal gastrointestinal stromal tumors

Ref.	Outcome parameters	LR group	PD group
Systematic review and meta-analysis
Chok et al[61] (n = 162)	Surgical morbidity; Oncologic outcomes	Better (20.7%); Better DFS (HR 2.07, 95%CI: 1.07–4.01), lower rate of distant metastasis (8.9% vs 25.8%, OR 0.28, 95%CI: 0.13–0.59)	Worse (48.3%) (RR 2.34, 95%CI: 1.61–3.42). Worse: Related to large tumor (≥ 5 cm) (76.0% vs 36.6%, OR 5.49, 95%CI: 1.8–16.76), high mitotic count ≥ 5/50 HPF (33.7% vs 18.5%, OR 2.23, 95%CI: 1.22–4.08), high-risk classification (60.3% vs 32.0%, OR 3.23, 95%CI: 1.65–6.34) and which were located at D2 (80.5% vs 28.6%, OR 10.33, 95%CI: 5.22–20.47)
Shen et al[62] (n = 623)	Complications; Long term prognosis	Less; Better	More (OR 2.90; 95%CI: 1.90-4.42; P < 0.001); Worse (HR 1.93; 95%CI: 1.39-2.69; P < 0.001); Related to invasion of the D2, higher degree tumor mitosis (> 5/50 HPF) and high-risk classification (P < 0.001)
Zhou et al[63] (n = 1103)	Surgical outcomes	Better	Worse: Related to higher incidence of mitotic index > 5/50 HPF, high-risk classification, D2 tumor, tumor size, operative duration, intraoperative blood loss, blood transfusion requirement, morbidity, length of hospital stay and recurrence rate (P < 0.001)
Propensity score matching study
Wei et al[67] (n = 325)	Impact of surgical modalities on long term survival outcomes	Similar	Similar: OS (HR 1.160; 95%CI: 0.662-2.033); DSS (HR 1.208; 95%CI: 0.686-2.128)
Uppal et al[68] (n = 1084 of which 874 had resection)	Lymph node and stage; Survival; Adjuvant systemic therapy rate	Fewer and negative for disease; Better. 21.5%	Higher T3/4 stage, extra nodal involvement and performed more at academic center. Poorer, higher mortality, uninsured status. 31.3%

CI: Confidence interval; DFS: Disease-free survival; DSS: Disease-specific survival; HPF: High power field; HR: Hazard ratio; LR: Limited resection; OR: Odds ratio; OS: Overall survival; PD: Pancreaticoduodenectomy; RR: Relative risk.